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[Here's something I just learned about the PPO Advantage plan. I at first thought it might be good for those of us who want out of network doctors who will bill medicare to cover some expenses. . . much like a regular PPO. But I learned that only a small amount will be covered for my out of network doctor. So I may as well just get medigap. When just turning 65, the lowest premium is $150 a month. With the PPO advantage plan the maximum out of pocket is $3,300 a year not including copays for doctor visits. So if you see doctors a lot and have expensive medical bills, than the medigap plan is actually much less. Do the math. So if I need to see out of network doctors, I guess I'll just have to pay cash. I'm very selective about getting the best doctors I can.
Wow, I agree that is not a very good Advantage Plan. I am glad my PPO Advantage Plan is not like this one. But I guess it depends upon the area you are in as to what you can get.
Minervah - what kind of PPO advantage plan do you have?
Minervah - I'm curious what your plan covers. Have you used out of network doctors? Has yours covered very much of out of network fees? Where are you and what is your plan? Thanks!!
Minerva - I'm curious what your plan covers. Have you used out of network doctors? Has yours covered very much of out of network fees? Where are you and what is your plan? Thanks!!
I first checked with all my docs and I have a slew of them and they all said they accepted my Medicare Advantage Plan. When needing a new doctor I check the booklet I have that lists the participating physicians and choose.
My Plan has a $25 co-pay for specialists and a $10.00 co-pay for PCPs. I am in Oregon (Portland) and my Plan is Blue Cross Enhanced. There are less expensive Plans but because I go to the doctor a lot, the higher premium for the Enhanced Plan works for me.
Routine care is payed at 100%. Out of network and even reciprocal out-of-state care is covered but at a higher co-pay. So far none of my docs have been out-of-network.
mod cut I have a Medicare Advantage HMO plan which has tens of thousands of enrollees in Los Angeles and Orange Counties. It is Kaiser, and you can look it up on the Medicare website if you wish. I know exactly what my coverage is and what my co-pays are, as I have had the plan, and used it, for three and a half years now. I have absolutely no percentage co-pays - only dollar-amount co-pays, which are as follows: $5 for primary care physician and specialist visits, $75 for emergency room visits (up from $50 two years ago), $20 for lab work (up from $15 last year), $125 for outpatient surgery (up from $50 two years ago), $125 per day for hospitalization for the first 10 days - all subsequent days in a year's time are free. Once hospitalized, all procedures and tests are free.
I will repeat what I and others have posted in this and other threads: Not all Medicare Advantage Plans are created equal; there are enormous differences in different areas of the country, and probably even in different parts of the larger states. Just because you have a certain experience with your plan does not mean it's a universal experience. And likewise, I never claimed that my experience with my plan is a universal experience. You seem to be big on knowledge versus ignorance, so I'm sure you'll be grateful to me for pointing out that "equation" is not spelled "equassion".
Sorry Shuckapeafarms but I think that you should talk to another individual. The enrollment percentages for those eligible for Medicare are easy to find. This year, Medicare Advantage enrollment is around 27% and Medigap is 18%. Those in private and gov't plans (including military retirees) is about 31%. The remainder is less than 25% (I've read those not in any plan and only in original Medicare is around 10% - I think). Your 75% in original Medicare is simply invalid.
The only 20% co-pay that I'm aware of in my plan is for chemo. Others are fixed dollar amounts. And thats true for all the Advantage plans I've read this year (while looking for a PPO). However, original Medicare does have sliding scales for various things - perhaps you are thinking of it? And. of course, Medigap (F) is 20% always. Could that be it?
If you are so unhappy with Advantage plans, switch to the Medigap high deduct F. It is fairly cheap but you do need to include a drug plan.
Just a little clarification: The last two posts - mine and Khsoj's - were in response to a post which has been removed. If you didn't know that, you would wonder what we are talking about!
Does anyone else wish to support Khsoj? I would expect these private and government plans would be supplement type plans to the original Medicare--as otherwise they would be spending huge amounts of money--which could have been paid for by Medicare.
Actually, I was referring to the posting of 75% having ONLY Medicare without any other supplemental plans involved. Really, almost all health plans for participants age 65 and older rely on Medicare one way or the other.
I also am retiring this spring and nothing stays on my mind more everyday than what to do about insurance. As a postal worker, with APWU (Signa) insurance, and the post office taking a beating I am not so sure it is going to be there for me if I continue the Signa policy after retirement. Their portion paid may be discontinued on retirees if they're allowed to drop it. There are so many people taking early and normal retirements that I fear what the future options will be. We switched from Blue Cross to Signa because of the cost and suspecting we were only paying their high premiums for the name. Now after reading all your blogs (and thank God there is a blog like this and I finally found it..) at least there is someone that has been there/done that who is willing to share information. All the websites and PDF's are so confusing. Does anyone reading this have experience with Signa and how they compare with Blue Cross/Blue Shield's services? We are relocating to Virginia after retirement to be closer to our children. Part of the confusion is that nobody will give you an estimate unless you can give them a city/state. Even if you make one up the information provided still is confusing. Is there a "BEST" policy at a "LOW" cost? We were strongly considering medicare advantage untill we read about ObamaCare and its effect. My wife retired earlier and has Part A and coverage on my Signa as a spouse, and will not be penalized when we switch to Part B but the concern is what is the smart thing to do. Advantage?Medigap? Appreciate any comments..........
I also am retiring this spring and nothing stays on my mind more everyday than what to do about insurance. As a postal worker, with APWU (Signa) insurance, and the post office taking a beating I am not so sure it is going to be there for me if I continue the Signa policy after retirement. Their portion paid may be discontinued on retirees if they're allowed to drop it. There are so many people taking early and normal retirements that I fear what the future options will be. We switched from Blue Cross to Signa because of the cost and suspecting we were only paying their high premiums for the name. Now after reading all your blogs (and thank God there is a blog like this and I finally found it..) at least there is someone that has been there/done that who is willing to share information. All the websites and PDF's are so confusing. Does anyone reading this have experience with Signa and how they compare with Blue Cross/Blue Shield's services? We are relocating to Virginia after retirement to be closer to our children. Part of the confusion is that nobody will give you an estimate unless you can give them a city/state. Even if you make one up the information provided still is confusing. Is there a "BEST" policy at a "LOW" cost? We were strongly considering medicare advantage untill we read about ObamaCare and its effect. My wife retired earlier and has Part A and coverage on my Signa as a spouse, and will not be penalized when we switch to Part B but the concern is what is the smart thing to do. Advantage?Medigap? Appreciate any comments..........
First, you left out some critical information which might allow some of us to answer you intelligently, namely your ages. It appears you are both at least 65. Is that correct?
Second, you ask a question which would require us to start this thread all over again ("Advantage? Medigap?"). All these posts in the thread have been devoted to answering that very question (provided they are not off-topic).
Third, there is an important element of your situation, being a postal worker, which most of us do not know anything about unless we are also postal workers, either current or retired. Within the Postal Service, there must be some office or bureau which is in charge of medical benefits. I suggest you contact that office and inquire about what happens after you retire with regard to how your benefits from the Postal Service coordinate with Medicare once you turn 65. I'll bet they have some sort of pamphlet or brochure which explains that very thing. It would be a good place to start.
By the way, I don't blame you for being confused. This is a confusing topic.
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Minervah - what kind of PPO advantage plan do you have?
SooooooooStressfulllllll..
