SIGforum.com Main Page The Lounge Medicare Advantage Plans - anybody have one - pros and cons please
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Assault Accountant |
There is no network of physicians that I am required to use with the Aetna Medicare Advantage Plan. If the provider accepts Medicare then they will accept the Aetna Medicare Advantage PPO Plan that I have. __________________ Member NRA Member NYSRPA | |||
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His Royal Hiney |
It’s all a matter of personal cost-benefit calculation. I pay $54 for my Humana Supplemental Plan That’s a difference of $102 a month. The break even point for me to make it indifferent financially to go with my Medigap plan and your Medicare advantage plan is I have to get $5,144 worth of treatment at the Medicare approved amount. You look at the Medicare approved amount and the invoice amount, the Medicare approved amount is only 20% of the invoice amount. So doubling the $5,144 is conservative. This means every year, I have to get over $10,000 worth of invoices treatment to break even on the additional $102 if I were to go on your Medicare advantage plan. "It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946. | |||
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| Member |
^^^^^^^^^^^^^ You are confused. A PPO program provides a list of docs you must see to get favorable financial treatment. You may go outside the PPO but you will pay more. The insurance companies extract a discount from physicians in return for increasing referrals in the PPO. | |||
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| Member |
^^^^^^^^ Medicare Advantage plans extract a discount from participating physicians. Unless he needs the business badly why would he accept a discount for his services. Besides over fifty percent of docs are now employees of a hospital.The large hospital in our area refused to contract with UNH. There were no available docs and if you needed inpatient care you had to travel out of the area. It was resolved several months later,but lots of patients suffered. | |||
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| His Royal Hiney |
I found the drug plan process more complex. With any Medigap plan, you copays and deductibles are the same, just the premiums are different for each plan. With drug plans, within each plan, your copays (and total costs) are different based on which pharmacy within the plan you get your drugs from. There can be $500 a year or more between in-network pharmacies under the same plan. I didn’t realize this until 2 years in. Good thing is you can switch plans every year and you should check every year. Drug plans change the formularies and copays every year. What is regulated and consistent across plans is your deductible for the year and how much out of pocket in copays you have to pay before you’re 100% covered. It’s $2000 now. Before this year, the regulations were even more complex and expensive; something called the donut hole where, instead of paying just copays, you’re paying for the full cost of the drug before you hit the catastrophic stage where you pay zero. "It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946. | |||
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| His Royal Hiney |
Your post made me look more into the matter out of curiosity. You’re correct that you can go to any doctor who accepts Medicare but they do have in-network and out-of-network physicians and you will pay more for going to an out-of-network provider. I think the key way they keep costs down is that they require pre-authorization for certain procedures. I think this is how regular Medicare is going - requiring pre authorizations for certain procedures. "It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946. | |||
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| No More Mr. Nice Guy |
I currently have no coverage for "chronic" condition prescriptions, so I pay out of pocket. Not a big deal but not cheap, though our health coverage is inexpensive and otherwise very good. As far as Part D plans, at least in my zip code, compounding pharmacies aren't covered, and thus I am stuck out of pocket for the TRT product that works for me. The blood pressure Rx is quite inexpensive already, so any Part D plan is going to be useless for me with my existing prescriptions. Between Part B, Part D, and a supplement plan, my costs are going to double in a few months for worse coverage than we have today. Next year is even worse with an IRMAA penalty for selling our home. I sure wish I could opt out of Medicare completely (but get back all the money I and my employers paid into it). | |||
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| His Royal Hiney |
I laugh at the idiots who scream they want Medicare for all. Medicare is the most expensive health insurance plan my wife and I have been on. Just on monthly premium payments, I've never had to pay an employer program more than $185 a month and double that if I want to include my wife plus the 20% copays. "It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946. | |||
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thin skin can't win |
With the exclusion of the first $500K of gain from taxable income, this will not be an issue for many people. You only have integrity once. - imprezaguy02 | |||
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אַרְיֵה |
 הרחפת שלי מלאה בצלופחים | |||
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| Member |
United Health Care or as many docs say united no care. | |||
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| Member |
***slightly older thread*** Got back from radiation treatment and found a letter from my insurance company stating that my Advantage plan that I like so much is being terminated at the end of the year. The good news is I get to make the Advantage vs regular Medicare decision all over again since because the plan was terminated, I am entitled to a Medigap and a part D without any hassle. The bad news is I have to search through all the crap and make this decision all over again.  ____________ Pace | |||
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| Just because you can, doesn't mean you should |
I've been using Anthem/Blue Cross Part G and been happy. I've never had anyone that wouldn't take their card. I would make a list of your med's and there are sites you can put that into and they tell you which Part D is best to use. Also sign up for those GoodRx cards for free or almost free. You'd be surprised how many drugs are covered under those. I don't have any regular prescriptions but my wife has a few common cholesterol and other drugs. Very few cost her anything over $1.95. Also ask for advice at the pharmacist you're using. They should know the answers. ___________________________ Avoid buying ChiCom/CCP products whenever possible. | |||
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| His Royal Hiney |
I would go through your medicare.gov account and search for plans in your zip code. Then you would have to call the company directly. I find clickin on the link just takes you to the company's generic page and you're back to square one. Most companies give a discount if both you and your wife are with the company. To narrow your choice for you, your basic decision is whether you want the regular G plan which will cover all your copays after your annual $244 something deductible but the premiums are high or get High Deductible Plan G which comes with very low premiums but only kick in after so much copays have been paid like $2,000. High Deductible Plan G is basically a catastrophic plan to minimize your outlay. Regular G is if you expect to be continually sickly needing a lot of outpatient treatment every year. A simple calculation to help you decide is add the total year's premium for standard plan G plus the $260 Medicare annual deductible. Next, add the total year's premium for high deductible plan G plus the $260. The total cost for High Deductible plan G should be lower than the total cost for standard plan G. Then subtract the the total cost of the high deductible plan G from the total cost of the standard G. Divide this difference by 20%. The result is Medicare approved amount for the year which is the break even point. If you expect to require outpatient costs greater than that amount, you should get regular G. You'll be saving each year. If you expect to require significantly less than that amount, you should get High Deductible G. While the plan may make it look like you're paying for 'no benefits," you're protecting yourself against a catastrophic need while minimizing your premium costs. "It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946. | |||
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| Member |
I thought I read all of this thread from the start some while ago and appreciate everyones input. I can honestly tell you I'm just as confused as before about this entire subject of plans. Sorry. | |||
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| Member |
Thanks all. Anybody using a good Part D plan for really expensive drugs? ____________ Pace | |||
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| His Royal Hiney |
A really good Part D plan will be the one that will be the lowest out of pocket cost to you. Different plans have different copays for different drugs. Wait for the Part D Open Enrollment period which is from October 15 to December 7 each year. You would go go Medicare.gov. Sign in to your account. Go to Search for drug plans. Make sure you update the prescription drugs you use and their frequency. There's a menu for this. Once you have it updated, then you would enter your zip code, enter your preferred brick and mortar pharmacies near you. And the system will sort out the available plans for you in your zip code sorted at the top by your lowest out of pocket cost (Premiums plus total copays for your drugs for the next year). Then make your choice. Understand that within each plan, you will have different copays depending on which pharmacy you get your drugs from. Each plan will also have its own mail order pharmacy which is usually cheaper. It will also show if any of your preferred local pharmacy is out of network. Good luck. "It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946. | |||
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| Just because something is legal to do doesn't mean it is the smart thing to do. |
I am 74 and have a plan through my retirement and while it covers a lot the best I can see out there is to be poor and and get medicare & medicaid. My brother (now deceased) and one of my wife's friends is on it and they have the best of care and pay nothing. Integrity is doing the right thing, even when nobody is looking. | |||
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| No More Mr. Nice Guy |
I highly recommend using an agent to help you. You probably have dozens of Medigap plans available in your zip code, plus all the Advantage plans. My very recent experience is that almost none of the insurance companies put any useful information on their websites. They want to hook you into a phone call. You'd have to do that for every single one of the insurance companies, and then you'd have to further sift through each of the different plans they offer. You can find an agent with a web search or personal referral, I don't recall if the Medicare website gives a list of agents or not. Anyhow, the agents generally are enrolled with multiple companies, meaning they can sign you up and they do get a commission. Unlike if you call one insurance company where their agents only work for them. The independent agent should have a good understanding of the different plans available to you, and be able to direct you to which few are the best candidates, and help you make a final decision. All at zero cost to you. The Medicare website gives premiums for each of the many plans available to you, but I found that information can be wildly incorrect. | |||
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| No More Mr. Nice Guy |
The Medicare website can do the search for you, or you can use an agent. Either way you'll have to give the names and dosage of all your prescriptions, and the pharmacies you prefer to use. Then you'll get a bottom line number of overall total cost to you for the year for those medications, considering premiums, deductibles, copays, etc. Every year you can switch Part D without fear of refusal. I found the Medicare website very easy to use for Part D. My only qualm was giving up Rx information, but they'll know it all anyway when I start Medicare next month. They probably already have tentacles into the databases of all our medical records. | |||
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SIGforum.com Main Page The Lounge Medicare Advantage Plans - anybody have one - pros and cons please
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