Medicare and supplemental plans

[Dan Murphy]

Here, Illinois Blue Cross,

Basic HMO Advantage, In Network only--0 copay for PCP, 25 for referred specialist. 225 for days 1-7 in hospital, 2,950 max OOP

HMO/POS allows out of network, 0 PCP/35 specialist in net 60/70 out net 220 days 1-7 hospital in net 40% out net 3,450 OOP max in, no OOP max out

 

[barkley]

Most if not all will cover emergencies outside their coverage area but if you are a retiree and plan to spend a part of the year elsewhere, make sure the plan you look at will provide full coverage there

i will also caution anyone (in particular public employees) who will retire with insurance available to them-LOOK A YEAR OR TWO AHEAD at what the cost of those plans are for retirees, and esp. what they cost if you move from your current location.

many public employee retirement health plans are MUCH HIGHER in cost than for active employees and you may be very limited in your choice (or no choice at all-only one option) if you move from a certain mile radius of your employer. i'm a member of retired public employee group and this is a huge issue esp. if your employer no longer offers this as a benefit for more recently hired employees (my former stopped offering for new hires over a decade ago). by moving out of their hmo region i only had one choice-crazy, psycho expensive b/c they are trying to get as many retirees to opt out as possible. i have a family member who was kaiser covered for 40 years and moved to a location with kaiser hospitals/doctors but his coverage as a former state employee only permits kaiser if you live within the particular hmo plan coverage area near to the location of his former employer.

take the time to look at retiree costs for health insurance, you may be shocked at how much more they cost vs. what you pay as an active employee and will have to decide accordingly.

Finding a Doctor that accepts regular medicare was the biggest issue my mom had until Medicare Advantage plans became available here.

YES. despite having advantage plans in our region many doctors still have waiting lists to take on new medicare patients. if you are an existing patient with a doctor you do best to inquire if they will retain you when you get medicare, some will but others make you go on the wait list. if you plan to move you might want to get on a wait list at the new location well ahead of the move.



i have an advantage program-hmo which i pay $30 over the basic medicare premiums for. meds i was paying $200 a month for with my private insurance now run me less than $40 per month b/c i'm paying $3 or $5 for them vs. $20 or $35 co-pays.

 

[lynxstch]

@Frwinkley---I will add my 2 cents worth of costs. Same as everyone else for Medicare and part B deductibles. We have Aetna Supplemental Plan N..I pay $88.10 per month and hubby pays $104.59 We each pay $7 something for Part D Silver Script RX, and there is a $480 deductible for that this year, up from $445 last year. No co pay for PCP and regular Dr's, $20 for specialists (such as cardiologist). Lower tier drugs cost us $3 each (up from zero cost last year), and I think it's 25% of the upper tier ones. Luckily our hospital has a Patient Assistance Dept, that contacts drug company's to get some of ours free. (the higher cost ones, thankfully!).

We each had a hospital stay last year. Out of the $40,000 for hubby's, we paid one $20 co pay. For my $35,000, we paid one $20 co pay and 1 $69 for a separate hospital visit.

 

[barkley]

anyone else had some of their preventative meds convert to a zero copay? when i went to pick up a couple of mine and dh's this fall i was surprised to be told we didn't have to pay anything. pharmacy said that several of the medicare plans had designated a number of preventative meds to zero cost in an effort to encourage people to refill and take their meds (when cost of living goes up many seniors have to cut costs where they can and they endanger their health ).

 

[georgina]

A couple of DH's medications are zero copay but that is not new. He has Wellcare (or whatever it is now, I think someone else bought them).

I don't understand your situation. Medicare Advantage Plans are legally required to cover everything that Medicare covers at the same rate. The difference is the additional coverages they provide. So folks, do your homework. There seems to be a lot of confusion.

They can deny requested services. You need authorization for specialists.

Its from the NY Times so maybe paywall - https://www.nytimes.com/2018/10/13/us/politics/medicare-claims-private-plans.html

Medicare Advantage plans, the popular private-insurance alternative to the traditional Medicare program, have been improperly denying many medical claims to patients and physicians alike, federal investigators say in a new report.

The private plans, which now cover more than 20 million people — more than one-third of all Medicare beneficiaries — have an incentive to deny claims “in an attempt to increase their profits,” the report says.

The findings, by the inspector general at the Department of Health and Human Services, come as policies in Washington are creating new incentives for older Americans to enroll in Medicare Advantage plans. Some experts predict that the share of Medicare patients in the private plans could grow to one-half in a few years.

“Because Medicare Advantage covers so many beneficiaries, even low rates of inappropriately denied services or payment can create significant problems for many Medicare beneficiaries and their providers,” said the report by the inspector general, Daniel R. Levinson.

 

[tvguy]

A couple of DH's medications are zero copay but that is not new. He has Wellcare (or whatever it is now, I think someone else bought them).


They can deny requested services. You need authorization for specialists.

Its from the NY Times so maybe paywall - https://www.nytimes.com/2018/10/13/us/politics/medicare-claims-private-plans.html

Medicare Advantage plans, the popular private-insurance alternative to the traditional Medicare program, have been improperly denying many medical claims to patients and physicians alike, federal investigators say in a new report.

The private plans, which now cover more than 20 million people — more than one-third of all Medicare beneficiaries — have an incentive to deny claims “in an attempt to increase their profits,” the report says.

The findings, by the inspector general at the Department of Health and Human Services, come as policies in Washington are creating new incentives for older Americans to enroll in Medicare Advantage plans. Some experts predict that the share of Medicare patients in the private plans could grow to one-half in a few years.

“Because Medicare Advantage covers so many beneficiaries, even low rates of inappropriately denied services or payment can create significant problems for many Medicare beneficiaries and their providers,” said the report by the inspector general, Daniel R. Levinson.

Glad they are investigating. Because legally Medicare Advantage Plans have to pay for everything that Medicare pays for. Their benefit is the extra perks they offer since they can get services provided for a lower price than Mediare.

 

[tvguy]

i have an advantage program-hmo which i pay $30 over the basic medicare premiums for. meds i was paying $200 a month for with my private insurance now run me less than $40 per month b/c i'm paying $3 or $5 for them vs. $20 or $35 co-pays.

I'm using COBRA now. $1,400 a month for my wife and I with a 20% deductible. So Advantage plans are much cheaper and better coverage. We will be eligible for Medicare/Medicare Advantage in June for me, and November for my wife.

 

[longboard55]

They need to accept anyone when you first join but future changes are subject to review.

 

[lynxstch]

anyone else had some of their preventative meds convert to a zero copay? when i went to pick up a couple of mine and dh's this fall i was surprised to be told we didn't have to pay anything. pharmacy said that several of the medicare plans had designated a number of preventative meds to zero cost in an effort to encourage people to refill and take their meds (when cost of living goes up many seniors have to cut costs where they can and they endanger their health ).

Ours were the opposite..preventative or maintenance meds were 0 for us last year..this year they are $3

 

[Dan Murphy]

Ours were the opposite..preventative or maintenance meds were 0 for us last year..this year they are $3

Same here. But the premium went down a few cents a month, immaterially.

One piece of advice (not good giving advice on the Internet ), for some of my meds that are subject to the annual deductible in Part D (I think it is like $475) and/or are not 'tier 1 meds ($3 as above), I use the GoodRx app. It is great!!! If you have to pay for a med, subject to a deductible and/or a larger copay, try the app, Apple or Android. And I find, with most people thinking Walgreens is the place to go for meds, if paying, I find it most often the most costly. Generally, for those meds, I wind up at a local Mariano's, part of the Kroger chain. YMMV

 

[lynxstch]

Same here. But the premium went down a few cents a month, immaterially.

One piece of advice (not good giving advice on the Internet ), for some of my meds that are subject to the annual deductible in Part D (I think it is like $475) and/or are not 'tier 1 meds ($3 as above), I use the GoodRx app. It is great!!! If you have to pay for a med, subject to a deductible and/or a larger copay, try the app, Apple or Android. And I find, with most people thinking Walgreens is the place to go for meds, if paying, I find it most often the most costly. Generally, for those meds, I wind up at a local Mariano's, part of the Kroger chain. YMMV

I have used the Good RX app on my Amiodarone, but still costs me like $68 for 90 days. But both husband and I each take Farxiga and Entresto, which are like $138 each for 90 days. So both of those times 2. We now get drug assistance from the respective company's , and get both for free for the rest of the calendar year. My Eliquis (blood thinner), with Good RX would have been over $1200. As it was, even with the Silver Script price (and BTW the deductible for Part D is $480 this year) it cost me $1084.85 2 weeks ago. That did take care of my whole deductible and also took care of the 3% of adjusted gross income that the Eliquis company requires (Bristol Squibb Myer), but still made the Eliquis cost almost $600.My cardiologist got me patient assistance papers for that..and they faxed them over and I was approved to get my Eliquis free for the rest of the year..whew!

 

[OKbyme]

Very interesting thread as we are planning for retirement. Lot of moving parts!

As we get older, we may experience health issues, but as of now, we are both quite healthy; no meds, no major health issues, yearly exams.

The one issue I worry about is dental care. My older brother and his wife are spending thousands of dollars in dental care, and that is with a dental plan he was allowed to keep when he retired. A friend who works in dental care also commented about senior patients and the expensive issues they seem to have. DH has had issues in the past and wears a partial. I also have several crowns that are quite old, so if they go bad, that will be quite an expense.

Does anyone here pay for a dental plan in retirement? DH has one with work now, and it isn't cheap, so we only get it every couple of years if we start having more issues than normal.

 

[lanejudy]

I don't understand your situation. Medicare Advantage Plans are legally required to cover everything that Medicare covers at the same rate. The difference is the additional coverages they provide. So folks, do your homework. There seems to be a lot of confusion.

They cover the same on paper, but with more hoops to jump through and often different caps -- pre-authorization, required treatment "step"plan, restricted to certain providers, etc. And every plan has a different set of "administrators" who determine eligibility for various care, so BCBS may approve something that United Healthcare requires a step or additional testing or such (and vice versa). Based on my research (granted it was a few years ago now), Medicare Advantage plans are usually an HMO or PPO -- which may work fine in a highly populated area such as CA where so many folks are used to Kaiser-type healthcare but can be useless in a more rural setting. And one big thing I hear repeatedly about Medicare Advantage plans is while they appear to be a great deal when you are newly-retired younger and healthier, they can be monsters to deal with once more involved medical needs arise.

OP --

I teach in PA where PSERS (the PA retirement pension system) offers supplemental plans.

YOUR specific options for supplemental plans may differ vastly from others. As mentioned by several on this thread, plans differ based on geography anyway, but if you will be selecting from a set of plans offered through PSERS, it may still be different from your next-door-neighbor. I suggest chatting with some of the recent retirees to find out what they have, how they like it, how it works, and what it costs.

 

[tvguy]

They cover the same on paper, but with more hoops to jump through and often different caps -- pre-authorization, required treatment "step"plan, restricted to certain providers, etc. And every plan has a different set of "administrators" who determine eligibility for various care, so BCBS may approve something that United Healthcare requires a step or additional testing or such (and vice versa). Based on my research (granted it was a few years ago now), Medicare Advantage plans are usually an HMO or PPO -- which may work fine in a highly populated area such as CA where so many folks are used to Kaiser-type healthcare but can be useless in a more rural setting. And one big thing I hear repeatedly about Medicare Advantage plans is while they appear to be a great deal when you are newly-retired younger and healthier, they can be monsters to deal with once more involved medical needs arise.

OP --

YOUR specific options for supplemental plans may differ vastly from others. As mentioned by several on this thread, plans differ based on geography anyway, but if you will be selection from a set of plans offered through PSERS, it may still be different from your next-doo-neighbor. I suggest chatting with some of the recent retirees to find out what they have, how they like it, how it works, and what it costs.

Like I think I posted, my mom had a MCA plan for most of the 25 years she was covered by Medicare and she never had an issue. The last 13 months of her life she was diagnosed with cancer and had a stroke and had to move into a care facility. Never an issue with coverage.
But yes, ALL health insurance has issues it seems. My wife's best friend has coverage through California's Affordable Health Care act health exchange, Covered California. She lives in a town of 91,000 and not a single Primary Care Doctor takes Affordable Health Care Act insurance. She had to travel 150 miles for her care.

 

[lanejudy]

Like I think I posted, my mom had a MCA plan for most of the 25 years she was covered by Medicare and she never had an issue.

That's great. I'm glad it was a good plan for her. That doesn't mean it would be the best option for someone else.

 

[tvguy]

That's great. I'm glad it was a good plan for her. That doesn't mean it would be the best option for someone else.

Yes, you need to do your homework. I am just beginning to sort through 45+ plans for myself. I can't find anyone around here who doesn't have a Medicare Advantage Plan. Just so much better here than other options.

 

[tasha99]

Do you live in area with Medicare Advantage Plans? Those are private plans where Medicare pays a private insurance company to take you off their hands. Those companies throw in perks like free dental, free prescriptions, allowances for OTC medications, and some even kick back $144 a month of what Medicare pays them to cover back to you. I start my search next month as I will be 65 in June. Most of my friends are paying about $90 a month. That is in place of the $175 Medicare Part B costs.

Just be careful with Medicare Advantage plans. They sound better on paper, but I've seen patients have a lot of trouble with them. It probably depends on the plan; I'm sure some are better than others.

Here is my take on Medicare Advantage Plans versus regular Medicare. I was a nurse for my county in NJ as an aging and disability coordinator. I would call Medicare Advantage Plans Disadvantage Plans. Many times I had clients that could of used more time say in rehab but their plan would often deny. Needing more care say for cancer, watch what the policy covers and your co-pays. It may be less to begin with but watch co-pays. I also know a friend that was an insurance agent would would also NOT recommend an Advantage plan. I live in PA now and I for Aetna Medicare supplement plan I pay $125 (age 66) and my husband pays $152 (age 70). The county office for aging should have people who can help in figuring the best plan for you. Now remember to pick a Medicare Part D when you turn 65 or if you need later on you will be penalized for the rest of the time you have the Part D plan. Medicare Supplement Plans are to me the way to go. I just needed surgery which with the Dr's fee and hospital charge was $60,000. I already hit my yearly Medicare deductible so my out of pocket was zero.

I used to be an SLP working in skilled nursing, and Medicare Advantage plans were always the ones that would want to pull a patient from rehab while they were still making good progress and not yet at their prior level of function. They are cheaper, and look like they pay well on paper, but what I've seen is a lot of denials and patients having to go home before they were ready. I told my parents to NOT get a Medicare Advantage plan, because the consensus where I worked was that they weren't as good (and it's healthcare workers and social workers who see the patterns). But of course they did it anyway, lol.

 

[Gitelfor]

Consumer Reports has a very useful review of
Medicare Advantage plans, as well as a discussion about Medigap plans (Medicare supplement).

I find CP usually is a good resource for valuable and reliable information.

The official Medicare site has a very useful tool for comparing different options, based on your zip code. The site also provides ratings for different plans, with a five star rating being the highest. There are options to research drug coverage, as well.

The process to search is very easy to use and provides up-to-date, solid information.

 

[tvguy]

Just be careful with Medicare Advantage plans. They sound better on paper, but I've seen patients have a lot of trouble with them. It probably depends on the plan; I'm sure some are better than others.


I used to be an SLP working in skilled nursing, and Medicare Advantage plans were always the ones that would want to pull a patient from rehab while they were still making good progress and not yet at their prior level of function. They are cheaper, and look like they pay well on paper, but what I've seen is a lot of denials and patients having to go home before they were ready. I told my parents to NOT get a Medicare Advantage plan, because the consensus where I worked was that they weren't as good (and it's healthcare workers and social workers who see the patterns). But of course they did it anyway, lol.

Yes probably depends on the plan. Like I said, do your homework. After my mom's stroke the Rehab center was the one who sat down with me with an honest appraisal that she would not be making further progress in their opinion. Her insurance was willing to give her an automatic renewal for two more months, but the Therapist said we would be wasting our time and just frustrating my mom. And my mom as an RN was very pleased with her Medicare Advantage Plan. Like I think I posted above, during the last 13 months of her life we only had to pay co-pays on two Fire Department ambulance rides. The two private ambulance rides she had the company took what payment was as full payment. That steamed me because my mom paid taxes to that fire Department for 60 years, and two times she needs their services they charged $250.

 

[Frwinkley]

They cover the same on paper, but with more hoops to jump through and often different caps -- pre-authorization, required treatment "step"plan, restricted to certain providers, etc. And every plan has a different set of "administrators" who determine eligibility for various care, so BCBS may approve something that United Healthcare requires a step or additional testing or such (and vice versa). Based on my research (granted it was a few years ago now), Medicare Advantage plans are usually an HMO or PPO -- which may work fine in a highly populated area such as CA where so many folks are used to Kaiser-type healthcare but can be useless in a more rural setting. And one big thing I hear repeatedly about Medicare Advantage plans is while they appear to be a great deal when you are newly-retired younger and healthier, they can be monsters to deal with once more involved medical needs arise.

OP --

YOUR specific options for supplemental plans may differ vastly from others. As mentioned by several on this thread, plans differ based on geography anyway, but if you will be selecting from a set of plans offered through PSERS, it may still be different from your next-door-neighbor. I suggest chatting with some of the recent retirees to find out what they have, how they like it, how it works, and what it costs.

That is exactly my plan. I was more curious to see how what I could get compared to what others had and what they were paying.