Formerly worked for an HMO, ten years. Wrote customer appeals. Both spouse and I were in the Humana Medicare Advantage Plan in south FL, until we relocated to GA. If you are new to Medicare, and can scrape together premiums for a supplemental plan, in conjunction with Original Medicare, please stay away from the Advantage plans. Plus, you can switch back from a Medicare Advantage Plan, but would be subjected to underwriting. Neither of us can get through medical underwriting, but qualified to change to Original Medicare due to moving out of the FL Humana Plan area. What I did to evaluate, was enter three years’ copays, doctors, hospitals, drug copays, to weigh it against the supplemental premiums. It was a wash, so we went back on Original Medicare. Now we can be treated by the good doctors, don’t have to obtain referrals. Also, the Humana HMO was denying care left and right. When hubs had a stroke, for a completely blocked carotid artery, Humana dragged out the surgery for six months, which should have been done the day he had the stroke. Very routine for HMOs to deny medically necessary care. HMOs routinely use referral clerks to make your medical decisions, rarely even nurses. As far as I’m concerned, the grief we received by being forced to see sub-par providers, the constant appealing every single service we needed, was way too much work to fight the HMO to obtain that service. HMOs are a stay away, IMO.
I ditto the response about not liking Humana. I had my parents with them and they were a nightmare to deal with. Their customer service was horrible and one department did not speak to the other so I would have to explain the situation to multiple departments. I switched m dad over to blue shield and have been happy with them. It is very region specific who offers what so best to check with an insurance agent to find out what is offered in your area and then read reviews on the ones you are considering. Good luck.
Avoid Advantage Plans if you can. Stick with regular Medicare and select a Supplemental Plan at a level that meets your needs. Medicare provides information about what is covered by Supplemental Plans A-H. This may initially seem more expensive than an Advantage Plan, but you will not have co-pays and you will not need referrals and you will not be limited to doctors within a specific network. A drug plan would be a separate policy. Regular Medicare does not cover drugs, hearing aids, glasses etc. Those things are out-of-pocket and expensive, but regular Medicare plus a Supplemental is the best choice for flexibility.
Call your Local Office of Aging. They may be able to take you thru what is available in your State. My friend just did this and OA made it so much easier. Be aware of Medicare Advantages verses straight Medicare and a supplimental. I have a friend who needed surgery. The doctor was right up the street. Medicare covered him but he wasn't in the MA network. Open enrollment she went back to straight Medicare with a suppliment.
I don't know where you live. I was a nurse my life long and did NOT work for Kaiser, but since I have been retired these 15 years I have been on Kaiser and I LOVE it. I LOVE it. My partner as well. I never see a bill. I pay my copay, and that is IT. My bro, who I am currently POA for has United Health/AARP and I will say that their coverage is great for his hospitalizations, but the billing of each entity and person drives me nuts, the constant inflow of Medicare info and of what is covered. I have a massive GRID for all the entities, each of which uses billing system not out of their office but out of a company somewhere across the worlds. It drives me NUTS and that was for one 5 day hospitalization and 30 day rehab. So I sound like a Kaiser ad and I guess I am one. Sorry. Some admin may delete me. I have had people say "Well, you have to have their docs. " Right. But that is the way of it. You have a hospitalist all the time these days. And I love their docs, and I can CHANGE anyone I don't love. Once my partner ran into problems with a detached retina, and Kaiser actually offered to send us ANYWHERE if we chose another place. Turned out fine and we stayed right where we were. Another time my step daughter, also on Kaiser, was sent to UC hospital because she was so ill and needed non invasive gallbladder OR in their opinion for a stone in a duct; at that time the only endoscopic removals were done there. In any case, if you don't have them, I find while more expensive, that United Health covered very well for my bro, were very responsive when communicated with. I am unfamiliar with all others. It is a maze of them I am sure. Good luck. Hope folks will let us know who they have and if they are happy.
I contacted Medicare directly because I was so confused and they told me what I am telling you - find an agent.
You must know someone that is getting their Medicare plan through an agent.
I called my SIL and am using her agent.
You don't pay the agent but they have access to hundreds of insurance companies and plans - mine found me the best deal in just a few minutes. Ditto on the Drug Plan. Because I am not on any medications, I am able to go with the "lowest bid" for my drug plan.
I do the same on drugs because I am on no “maintenance” drugs. But I have found that when I do need a drug that the GoodRX card discount gives me a better price than the insurance policy does. But I keep the insurance in case I do someday need to use drugs on a regular basis. There is a penalty for not having had the drug plan from the time you were eligible although you can still sign up for one when needed.
There are there are a lot of entities that offer free seminars on Medicare and how it works, comparison of risk under different plans, etc. You want to be sure they're not trying to sell you something, though. We are very pleased with our experience.
Some things nobody tells you, and we've learned the hard way. If you don't go on Medicare as soon as you are age-wise eligible, your effective date could be set some months in the past. This could complicate your HRA (health retirement account) if you have one, and your tax filing. Consult with your employer sooner rather than later.
Whatever your medical insurance has been in the past, if Medicare replaces that insurance, make very sure that Medicare's own records show that they are your only coverage. I.e., that they are the primary. Call 855-798-2627 Medicare coordination of benefits. Also, make sure any doctors you use remove your former insurance from their records. Otherwise, Medicare will decline claims because they are not primary, or the doctor will send claims to your former Insurance Company and the claims will be declined. Wastes a lot of time and causes lots of frustration.
And while you're talking to MediCare at the phone number above, give them permission to discuss your account with your spouse or other trusted representative.
My only experience has been with my husband and my father. My husband got a medigap plan from United Healthcare and it we went through knee surgery and many expenses involved with his brain tumor and we never had to pay anything. We decided to go with medigap due to the fact he had many health issues and we knew that our expenses for any given year would only be the cost of the premiums which were about 170 a month. My father has a Medicare advantage plan through Kaiser and dealing with them has not been good. he has a lot of co-pays and there have been a lot of other issues with his care. He pays the same amount per month we did for my husband’s medigap plan. If you go with a Medicare advantage plan you cannot then change to a medigap. But you can go to an advantage plan after medi gap if you want. Seeing the differences has convinced me to go with medigap and be able to keep my same doctor as well.
You've absolutely got it right! I started out with MA plans - under several companies, including AARP/United Health, which was the worst! Besides a considerable monthly premium to the company I paid through the nose for co-pays to docs, procedures (scans, etc.), ER visits, etc. I started out with Kaiser when first eligible and that was when Obamacare first started, and Kaiser (which I'd had as regular insur. before that because I couldn't switch at that point). I personally hate Kaiser? Their "Sr. Advantage" plan is no better - or less expensive - than anyone's "HMO" Advantage plans. Through a fortuitous situation (my Advantage plan company discontinued my particular plan) I had the option of signing up for any plan as if I'd never had Medicare yet. I chose a Medigap policy, and there is no comparison to how much better it is! My monthly premiums are somewhat higher - but not that much - and after the 80% covered by "original/basic" Medicare, the Medigap (Part G) plan covers all of the remaining 20%. I have a $198/year co-pay and then it's gravy! One thing? If you didn't opt for the Medigap policy when you were first eligible, you might still be able to switch but it would probably be more expensive and they can then require info on pre-existing conditions, etc., and refuse you...
GirlSaylor.... Since you and hubs have multiple health issues, this is only a suggestion..... I watch a Chiropractor on YouTube who is very health oriented and knowledgeable about how our bodies work. He's helped many people to reverse their diabetes, go off meds, improve their health tremendously....his name is Dr Eric Berg.... his videos are short, concise and to the point. But, imagine going totally healthy, organic and such, and getting healthy enough to stop the meds, perhaps ending the pain, and improving one's life! So, that's a suggestion...to check out this guy's videos! They are really interesting and educational! May God be with you, and to all who read this. Shalom!
Please note that if you enroll in Medicare Advantage Plan and later wanted to enroll in a Medicare Supplement Plan, the latter could be more benefit enriched and you will pay a higher premium than if you enroll with the Medicare Supplement now at age 65 due to being underwritten for adverse selection.
The most we have to pay out-of-pocket for the entire year is $4,100 each. We now have no copay for primary care visits, and $35 for specialists. A trip to the ER costs $90. Diagnostic tests and procedures $35 copay, lab services $10 copay, CT scans $75 copay, x-rays $20 copay. Hospital stays are $300 per day for days 1-5 and zero after that. Most screening tests and immunizations are free of charge, and we can be reimbursed up to $500 a year for dental expenses from any dental provider.
One additional item I thought of the other night. My DH is 68 years of age and also has Medicare and AARP Medicare Supplemental through United Health Care - also Plan letter "F," same as me. When his pc doctor was billing him $40, I actually went down to his pc doctor's office twice to clear this faux charge up. The pc doctor told me twice "It is owed to us." So I paid on visit #2. Then a few months went by and we received a check from our Medicare Supplemental Insurance in the exact amount of $40!
This is better called the Medigap supplemental policy because people just enrolling have trouble understanding the difference between this and Medicare Advantage plans...
A drug plan would be a separate policy. Regular Medicare does not cover drugs, hearing aids, glasses etc. Those things are out-of-pocket and expensive, but regular Medicare plus a Supplemental is the best choice for flexibility.
So I sound like a Kaiser ad and I guess I am one. Sorry. Some admin may delete me. I have had people say "Well, you have to have their docs. " Right. But that is the way of it. You have a hospitalist all the time these days. And I love their docs, and I can CHANGE anyone I don't love. Once my partner ran into problems with a detached retina, and Kaiser actually offered to send us ANYWHERE if we chose another place. Turned out fine and we stayed right where we were. Another time my step daughter, also on Kaiser, was sent to UC hospital because she was so ill and needed non invasive gallbladder OR in their opinion for a stone in a duct; at that time the only endoscopic removals were done there.
In any case, if you don't have them, I find while more expensive, that United Health covered very well for my bro, were very responsive when communicated with. I am unfamiliar with all others. It is a maze of them I am sure. Good luck. Hope folks will let us know who they have and if they are happy.
You must know someone that is getting their Medicare plan through an agent.
I called my SIL and am using her agent.
You don't pay the agent but they have access to hundreds of insurance companies and plans - mine found me the best deal in just a few minutes. Ditto on the Drug Plan. Because I am not on any medications, I am able to go with the "lowest bid" for my drug plan.
There is a penalty for not having had the drug plan from the time you were eligible although you can still sign up for one when needed.
There are there are a lot of entities that offer free seminars on Medicare and how it works, comparison of risk under different plans, etc. You want to be sure they're not trying to sell you something, though. We are very pleased with our experience.
Some things nobody tells you, and we've learned the hard way. If you don't go on Medicare as soon as you are age-wise eligible, your effective date could be set some months in the past. This could complicate your HRA (health retirement account) if you have one, and your tax filing. Consult with your employer sooner rather than later.
Whatever your medical insurance has been in the past, if Medicare replaces that insurance, make very sure that Medicare's own records show that they are your only coverage. I.e., that they are the primary. Call 855-798-2627 Medicare coordination of benefits. Also, make sure any doctors you use remove your former insurance from their records. Otherwise, Medicare will decline claims because they are not primary, or the doctor will send claims to your former Insurance Company and the claims will be declined. Wastes a lot of time and causes lots of frustration.
And while you're talking to MediCare at the phone number above, give them permission to discuss your account with your spouse or other trusted representative.
Since you and hubs have multiple health issues, this is only a suggestion.....
I watch a Chiropractor on YouTube who is very health oriented and knowledgeable about how our bodies work. He's helped many people to reverse their diabetes, go off meds, improve their health tremendously....his name is Dr Eric Berg.... his videos are short, concise and to the point. But, imagine going totally healthy, organic and such, and getting healthy enough to stop the meds, perhaps ending the pain, and improving one's life!
So, that's a suggestion...to check out this guy's videos! They are really interesting and educational!
May God be with you, and to all who read this. Shalom!
So far it's been a wonderful deal for us.