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Well, I'm on Advantage through United Health Care and have to call UHC if I travel. They have something called a Passport Program. Oddly enough, they have no in-network/passport providers in Northern WI (and lots of other places, either) where my family has a vacation lake place and where I'm most apt to go annually. It does cover ER visits overseas, but I suspect I'd have quite a time getting them to process claims from overseas and in northern WI if by chance I had to visit a clinic, there. Technically, I'm stuck w/30% for out-of-network providers and I assume I'd have to submit the claims myself. Not liking that idea, either.
So, not all Advantage plans are very flexible. I'm probably going back to Original Medicare with a high-deductible F this fall through BCBS. Only $53/mo, $2k deductible, which is better than the $4,450 max out-of-pocket I could potentially be stuck with in Advantage. Then if something terrible happens in Minocqua, WI, I can visit the clinic there, or the one in Marshfield, and not worry about it being out-of-network. Both clinics take Medicare patients, but are not in-network with UHC.
The Marshfield medical system pulled out of pretty much every major national insurance carrier so they aren't "in-network" for pretty much everyone unless you use their own plan.
Its really strange. Some of the insurance sales/brokerages say that the high-deductible F is a bad choice but the more I look at it the better I like it. Something to decide on later this fall. Thats why I've started reading this forum, to see if anyone has had personal experience with it.
There's no difference between high-deductible F and regular F, except the high premium for regular F, which I can't stomach paying every year whether I use it or not. I don't doctor. It would be a very rare series of years where year-in and year-out I incurred $2,000 in charges in 20% Medicare copays/deductibles. And, even if I do, so what? Premium is over $2k/year now for regular F in my state, so it's almost a wash. I'm gambling $600/yr I won't be using the insurance, all that much. If I do, well, I'm covered, and the extra $600 won't break the bank, either.
Yes, you are right. Thats exactly what I've been thinking. In fact, I've been categorizing it mentally as a Medicare Advantage plan with a $2,070 max out-of-pocket. Given the medical history for me and my wife, it'd take a trip to the hospital for one of us in order to hit the $2,070 cap. But in that event, there'd be some pretty high co-pays in our Medicare Advantage plan anyway.
Yup. The only thing you'd be missing would be drug coverage. Since I don't take medication, that doesn't worry me at this point. The flexibility in providers, the more I think about it, is the kicker. I don't want to have be calling ahead of time if I travel, or worry about in-network/out-of-network when I'm away from home for any extended period - and $4,450 out-of-pocket, to boot. I pay zero for the Advantage Plan, so I suppose this is how they make up for no premium.
Also, the Advantage Plans make out like bandits. Govt. pays them $700/mo per enrollee. Still, they require copays. My plan is $20PCP/$40Specialist/$50ER. Gripes me no end when I know they're collecting $700/mo for me each and every month and I'm still stuck w/copays for routine doctor visits.
Last edited by Ariadne22; 07-26-2012 at 01:56 PM..
I can take a vacation anywhere, international travel included.
What I can't do is 3 months here, 6 months there.
I think that you knew that.
Actually I didn't know it (or not know it). Never thought about it. Since - except for vacations (not very long) - I spend all of my time here - and have never thought about the Medicare implications of living in 2 places.
I would look closely at what your plan covers in terms of international travel. IIRC - Medicare doesn't cover anything. My Plan F only covers 80% up to a lifetime maximum benefit of $50k (with a $250 deductible). No coverage after the 60th day of a trip outside the US. OTOH - supplemental medical travel insurance doesn't seem to be that expensive (I'm in the process of buying a policy for an upcoming trip). On the third hand - we're going to Sweden. A medical policy might cost more (or be unavailable) if we were going to Nigeria or similar. Robyn
Its really strange. Some of the insurance sales/brokerages say that the high-deductible F is a bad choice but the more I look at it the better I like it. Something to decide on later this fall. Thats why I've started reading this forum, to see if anyone has had personal experience with it.
Did the sales people say why it's a bad deal? FWIW - I would have bought a high deductible F except that the company I wanted to use doesn't offer that policy where I live. Robyn
Yup. The only thing you'd be missing would be drug coverage. Since I don't take medication, that doesn't worry me at this point. The flexibility in providers, the more I think about it, is the kicker. I don't want to have be calling ahead of time if I travel, or worry about in-network/out-of-network when I'm away from home for any extended period - and $4,450 out-of-pocket, to boot. I pay zero for the Advantage Plan, so I suppose this is how they make up for no premium.
Also, the Advantage Plans make out like bandits. Govt. pays them $700/mo per enrollee. Still, they require copays. My plan is $20PCP/$40Specialist/$50ER. Gripes me no end when I know they're collecting $700/mo for me each and every month and I'm still stuck w/copays for routine doctor visits.
A person never knows when he/she might need expensive medication(s) that would be covered under Part D. For example - if you were diagnosed with certain kinds of cancer - you might need some very expensive drugs. Note that my husband and I picked the UHC Part D plan because - at least where we live - it seemed to have the most comprehensive drug formulary when it came to expensive drugs (we don't need any of them now - but who knows in the future?). Many Part D plans don't cover (m)any expensive drugs.
My understanding is that MA providers get about 115% (more or less) of what the government pays for regular Medicare. Which is probably about 115% of the government costs for Parts A (free to Medicare beneficiaries) and Part B (about $100 a month these days for most people - and 75% government subsidized - so the total monthly cost is about $400 a month). So if Medicare Part A costs the government about $200 a month - that would be a total of about $600 - and 115% of that would be close to $700 a month. Note that most people on MA would probably pay a heck of a lot more in co-pays without Advantage plans. And that's one reason why the Medigap policies that eliminate most/all co-pays cost more than MA IMO. Robyn
I had an advantage plan that cost me nothing. When I moved to my new area I was told there were no advantage plans available here. I decided to go with a medigap insurance from a well known firm. After the first year I got hit with a 25% increase in premium even thought I had no major cost. I talked to one of the insurance companies reps and he said they go up every year and sometime have increases through the year. The the rate of 25% a year increases it won't be too long before I can no longer afford medigap insurance leaving me with Medicare alone.
I know one fellow in NJ who did not have anything other than Medicare. He was dx'ed with prostrate cancer and treated with radiation. He told me he got a bill from the radiologist for $16k. I told him Medicare care would pay most of that. He then told me that bill was after Medicare had paid their share. He said he told the radiologist he had no money and is sending them $100 a month. The medical facility seems to accept the payment plan he offered as they took no legal action. This person owns his home and has a half a mil in the bank and investments.
I personally think it is outrageous that seniors must pay for Medicare, pay for a medigap plan, pay for a prescription plan, and still have deductibles.
I'm turning 65 in 2 months and starting Medicare, and I am still quite confused on whether to purchase:
1) a Medicare Advantage Plan or 2) a Medicap policy to supplement original Medicare.
and then, of course, prescription drug coverage.
It all seems so confusing after reading thru all of the threads in this forum, and all of the informational literature and publications at medicare.gov plus brochures from other sources.
I'm turning 65 in 2 months and starting Medicare, and I am still quite confused on whether to purchase:
1) a Medicare Advantage Plan or 2) a Medicap policy to supplement original Medicare.
and then, of course, prescription drug coverage.
It all seems so confusing after reading thru all of the threads in this forum, and all of the informational literature and publications at medicare.gov plus brochures from other sources.
I am baffled as to what to do.
Happy 65th Birthday! I'm a September baby - guess you're an October baby .
I'll try to make it easy for you. Can you afford to buy Medicare Part B - a really good Medigap policy (like plan F) and a really good Part D Plan? As well as pay your co-pays on the drugs you take under the good Part D plan* - and anything you might have to pay under the "donut hole"? If the answer to all of this is yes - go for it. Once you're on Medicare - it is easier to "trade down" than to trade up. This is an area where you don't want to pinch pennies unless you have to.
I highly recommend trying to find a good insurance agent who specializes in this area who represents lots of companies. The agent will get a commission no matter what you buy (and you won't pay any more) - so it's in his/her interest to sell you something that will be right for you (so you'll stick with it - and he/she will continue to collect a commission ). We have an agent - and he's excellent. He printed out charts for us comparing all the different plans from different companies that looked like they would suit our needs. We sat down at the "kitchen table" with him - and made a decision. Note that we ultimately went with AARP UHC plans (you can buy them through independent agents as well as AARP). Mostly because we've had 4 parents on those plans both here in Florida and in NC - and never had any problems.
Finally - keep in mind that when it comes to Medigap/Part D and Medicare Advantage Plans - there are a lot of geographical differences (in terms of the plans available in particular areas - and what they cost). Also - in the case of Medicare Advantage plans - what the networks are. So it is really hard for you to reach a conclusion on what's best for you on the basis of messages here (unless you live in the same exact geographical place as a particular poster and are in the same financial/health/etc. circumstances). Perhaps the most extreme example of this is Escort Rider - who uses Kaiser in the greater Los Angeles area. He really seems to like it - but it's an option most of us don't have. Robyn
*When it comes to drugs - don't only look at plan co-pays. Shop around for price without using your Part D. For example - we use Costco. And it is often cheaper (or much cheaper) for us to pay cash at Costco for 100 generic statins or even generic Lipitor these days than paying seemingly small Part D co-pays. For example - I pay $9.99 for 100 generic statins out of pocket at Costco - and my co-pay - were I to use Part D would be $10 for a 30 day supply.
Also - make sure any Part D plan covers the drugs you use or might have to use because of any diseases/conditions you have (plan formularies differ). Also note that the Medicare Part D formulary doesn't cover some drugs at all (in which case no Part D plan will cover them).
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