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yeah, I just looked again, and my drug costs under the MA plan with actual drugs plugged in are actually under $1000 for the year. When the agent ran the numbers for me on the BCBS drug plan, they were $4500 per year. (that's with 50% extra help on both plans).
it really is a different can of worms depending on where you live. I know some states have really bad availability of providers under their MA plans.
my sister was in WI also and had your same supplement, i think.
since I direct messaged you my zip code, you have probably seen by now that there are no $2140 oop plans in my area. The supplements are all $3000-$6000 oop. so the MA plan at $4000 oop, with my current providers, current drugs at 1/4 the price, and a bunch of preventative stuff was a no brainer. it's still too much money with my income and I definitely will run the numbers again in the fall--
ince I direct messaged you my zip code, you have probably seen by now that there are no $2140 oop plans in my area. The supplements are all $3000-$6000 oop. so the MA plan at $4000 oop, with my current providers, current drugs at 1/4 the price, and a bunch of preventative stuff was a no brainer. it's still too much money with my income and I definitely will run the numbers again in the fall--
Actually, I did find hd-F carriers in your area - again. Something is wrong with your browser if you're not getting this.
Here's a screen shot of part of that search page - hd-F right at the top:
Anyway, the drug costs are probably the dealbreaker for you.
Last edited by Ariadne22; 04-28-2014 at 09:16 PM..
You should know even though UHC and Humana have bad MA reputations, they can't play games on the Medigaps. Their behavior is entirely different on the Medigaps.
That is good to know.
Funny, over the weekend I asked a friend (who is 74) what plan she has. She has a MA plan through AARP which is an HMO plan; said it costs her "$66/month on top of the Medicare premium" and includes part D. Obviously it's that low because it's an HMO plan rather than a PPO; she lives in the same county as I do, so that's not the difference. Anyway, she mentioned that she signed up with them when she was 65 and has "just let it keep renewing every year" and "never bothered with looking at anything else" because "as long as she doesn't have to lay out any money except the occasional copay, she doesn't care". This boggled my mind because I know she is living in a very fixed income and money is tight and has been for years; yet she doesn't want to "bother" checking to see if another plan might suit her needs better.
It's possible she is in an area where having an Advantage plan is both economical and pretty inclusive when it comes to choice of doctors, etc.
She may be quite happy with the cost and having the doctors she is used to.
In our home county in NY, seems like every doctor participates in the two main HMOs.
As much as I think a PPO is preferable in most cases, I might have joined one of them if we didn't spend half the year out of the coverage area.
She also has a primary care doctor who she's very happy with, and has been with for a long time. Unfortunately that office hasn't been taking any new patients for several years and has no plans to in the future.
However, I have never in my entire adult life had a primary care/GP who wasn't either useless (clueless) or a disaster. And these were all via references from people I know! Specialists in my area won't refer to primary care doctors for some reason, no clue why. Anyway I could tell you stories about my former GPs that would curl your hair, lol. I am 100% disgusted with the lot of them; at best they are jack of all trades and master of none. That's why I refuse to consider an HMO, don't want to be in a gatekeeper situation ever.
She also has a primary care doctor who she's very happy with, and has been with for a long time. Unfortunately that office hasn't been taking any new patients for several years and has no plans to in the future.
However, I have never in my entire adult life had a primary care/GP who wasn't either useless (clueless) or a disaster. And these were all via references from people I know! Specialists in my area won't refer to primary care doctors for some reason, no clue why. Anyway I could tell you stories about my former GPs that would curl your hair, lol. I am 100% disgusted with the lot of them; at best they are jack of all trades and master of none. That's why I refuse to consider an HMO, don't want to be in a gatekeeper situation ever.
Sorry to hear you have had bad luck with GP's. My luck has been about 50/50 and I will drive 20 miles to see the one I have now. Saw her for 5 years, then moved, started with a new one, and went back. A good GP is worth a million bucks, LOL. She happens to be a provider under regular employer policies, PPO's, Medicare, Medicaid, and also HMO's in this area. She interned at Mayo and works part-time. I always have the option of seeing someone else if I need to be urgently seen.
Anyway, after all that discussion before (sorry to semi-hijack the thread) I learned that Medicare Supplement Plan F high deductible only covers 50% of outpatient therapy. I have a therapist so that wouldn't work for me. And I checked all the ones Adriane22 (sp?) posted and although they said they had policies in MN, several of them only covered certain counties when I went to their websites.
So I am back to my currently chosen Medica Advantage Plan, or going to a BCBS Health Plan (MN Cost Plan) plus a separate Part D plan during open enrollment if I get "gatekeeper phobia." I start June 1.
You've really gotta check out the fine points when going with one of these Medicare policies. Ugghh!!!
I had a very illuminating conversation today with the office manager at my oncologist's office after I went there for my regular 4-month checkup. She's the one who handles ALL of the billing and many other things besides. I explained my situation and asked for her input.
Her recommendation was to definitely go with regular Medicare and also one of the Medigap policies if I have concerns about the copays/coinsurance, especially the one issued by AARP. She said the AARP advantage plans are a disaster but the Medigap ones are great (go figure, lol).
Her parents are my age and were originally considering an advantage plan "because it seems simpler". She explained to them that those plans require authorization for almost everything, and it can easily become a nightmare. For example, one of their new patients has a BCBS Advantage plan and is supposed to start a chemo regimen that requires regular heart scans every 3 mos for a year, plus a starting baseline. Best practice is to get MUGA scans which are the most accurate but an alternative is an echocardogram which gives the result in a "range" rather than an actual number. The two prices are about $400 vs $150 for the echo. But the patient's Advantage plan will only authorize the cheaper scan, despite the fact that both the patient AND the oncologist want to use the best-practice MUGA. The oncologist was trying to explain all this to the plan's "consulting physician" in order to get him to support authorizing the MUGAs; know what kind of "consulting physician" he had to talk to? A gastroenterologist. So you've got a gastroenterologist being paid by the insurance company in order to make decisions about an oncology treatment that affects the heart. It boggles the mind.
I can relate to all this because I had to have that kind of chemo myself. I had no insurance and so there was nobody to tell me that I couldn't have what I wanted, which was the MUGA scans. Yes it cost me more but I had peace of mind which I wouldn't have had with just the echos.
She also said that many times the Advantage authorizations get so bogged down that patients can't even adhere to the chemo schedules that they need to follow, because something "didn't come through" or is "under review". Then the patient gets upset, the oncologist gets upset about not being able to give proper care when needed, and everyone feels like their hands are tied.
None of that nonsense happens with traditional Medicare and Medigaps. No referrals. No authorizations. No delays.
It was a real eye opener and made my decision for me. Now I just have to decide what "letter" Medigap policy I want to get.
Her recommendation was to definitely go with regular Medicare and also one of the Medigap policies if I have concerns about the copays/coinsurance, especially the one issued by AARP. She said the AARP advantage plans are a disaster but the Medigap ones are great (go figure, lol).
Actually, it is not a 'go figure' at all. It's ALL ABOUT THE MONEY.
The Advantage plans are paid a certain sum by Medicare per enrollee - and then dole out the benefits - all with the goal of profit. Whatever these companies get from Medicare that is not paid out, they keep. They make decisions on your medical benefits.
Monthly payments to these plans vary between $700-$1200 per enrollee, depending on the state.
The Medigaps, on the other hand, do NOT allow any decision making on the part of the insurers. The insurers MUST PAY the 20% and/or excess charges Medicare does not pay. The insurers have absolutely NO CONTROL on these payments - other than any underwriting they may do before they accept Medicare enrollees for their plans. If the charge is Medicare-approved, the Medigap must pay its share.
I had trouble with the United Health Care AARP Medicare Advantage plan the few times I used it - very slow paying their in-network providers, denied getting paperwork, one payment not made for a year. Lot of trouble for totally nonnegotiable routine office visits. Zero premium was nice, but I have zero tolerance for game-playing, which many MAs do.
I am now on the high-deductible Medigap F as discussed upthread. There is no way I want to be fighting with the morons at UHC - or any other insurer - ever again.
Everything that billing person told you is exactly what we've been discussing on this board for a couple of years now when weighing MAs against the Medigaps. Some MAs do a very good job. UHC AARP is not one of them, nor is Humana.
Quote:
Originally Posted by StressedOutNYer
None of that nonsense happens with traditional Medicare and Medigaps. No referrals. No authorizations. No delays.
It was a real eye opener and made my decision for me. Now I just have to decide what "letter" Medigap policy I want to get.
Oh, yes, there is plenty of testimony on CD from people who've switched from MAs to Medigaps. Night and day difference.
Medigaps are usually always preferable - if you can afford them. Medigap G or F are the best. Others are cost-sharing, some with still relatively high premiums, and don't cover excess charges.
As I said, I have the hd-F - premium $76/mo. I pay the first $2,140 of the 20%/excess charges that Medicare doesn't pay. After that, I'm home free. I don't doctor at all, so this is a good plan for me. No Part D. I don't need it.
You mention oncology. Sounds to me like you should not be looking at any type of a Medigap cost-sharing, but should spring for the F or G. You still need to buy a Part D for medication.
You mention oncology. Sounds to me like you should not be looking at any type of a Medigap cost-sharing, but should spring for the F or G. You still need to buy a Part D for medication.
Luckily the high-cost part of my cancer treatment is behind me. I went through it in 2010-2011 but after the year's worth of chemo was over, best practice is to have regular follow-up checkups by the surgeon and oncologist until I hit the five-year mark, then it's just yearly. In fact I got the go-ahead from my surgeon just last month to move to the one-year checkup routine; I'm on a 5- to 6-month checkup at the oncologist's until the end of next year, at which time I'll probably move to just a yearly visit to her also, until I hit the 8-years-out mark (when statistically my risk of recurrence will be the same as someone who never had that kind of cancer). The surgeon counts the years from date of surgery but the oncologist counts the years from date of completion of chemo, hence the approximate 1-year differential.
My kind of cancer is not treatable by any kind of oral meds so I never had any Part D-type drug expenses even when I had the chemo (which would have been covered by Part B, if I'd had Medicare at the time). Even the (awesome) anti-nausea med was given as part of the chemo infusion. I'm planing to buy the cheapest Part D available, because I don't think I have ever in my life had to pay $300 in any one year for prescriptions. The occasional generic ($8 or $10) antibiotic if needed, is about it. So I wouldn't even meet a yearly deductible, LOL. If things ever change (hopefully not) I would "upgrade" to a better Part D when possible, at that point.
I have to check into prices for the Medigaps. Problem is, right now and until late next year, I am literally living on a shoestring and every penny counts. So I may simply not be able to afford one of the best Medigap plans at this point in time and may have to take one that covers the Part A deductible and coinsurance, plus the Part B coinsurance but not the deductible. I never travel outside the USA so I don't need that coverage. Then when I can afford the F or G plan I could switch during next year's open enrollment period.
I *can* change my Medigap policy during annual open enrollment periods, can't I? I don't have to stay with my first choice "letter" (or even same company) forever, right?
So I may simply not be able to afford one of the best Medigap plans at this point in time and may have to take one that covers the Part A deductible and coinsurance, plus the Part B coinsurance but not the deductible.
The Part B is insignificant at $147. That is NOT why the the best Medigaps cost more. The higher cost is because those plans cover 100% of the 20% copay AND excess charges (aka limiting charge) and 100% of the hospital deductible.
The hospital deductible IS significant at $1,216, because that deductible applies every time you are admitted unless that admission occurs within the same benefit period for a particular condition. Many people have also cited copays and excess charges as being very costly.
For example, Mayo does not accept Medicare assignment but does accept Medicare patients. Mayo is allowed to bill 15% excess over and above the Medicare-approved charge. That 15% charge is all on you. Many providers, not just Mayo, are nonparticipating providers and do charge the 15% excess/limiting charge.
The ONLY plans which pay excess charges are Plans F & G.
If you missed it, this was posted upthread on that issue:
Quote:
Originally Posted by Ariadne22
Doctors who accept Medicare assignment must take the Medicare-allowed charge as a reimbursement, with you (or your Medigap) paying the additional 20% copay. These are called participating providers.
Doctors who accept Medicare patients but not Medicare assignment are called non-participating providers. Non-participating providers are allowed to charge an additional 15% excess (aka limiting) charge.
For non-participating providers, Medicare pays its allowed charge. Your Medigap - or you - pay the copay PLUS the 15% excess/limiting charge.
Medigap Plans F&G will pay the excess charge and copays. But, if you do not have a plan which pays excess charges and has cost-sharing on copays, that additional 15% and/or copay falls on you.
I *can* change my Medigap policy during annual open enrollment periods, can't I? I don't have to stay with my first choice "letter" (or even same company) forever, right?
MAYBE -- Switching later is conditional on your health history.
You only get one free bite at the apple - when you first enroll. No company can deny you a Medigap or MA now, when you first become eligible for Medicare.
ACA did not remove the preexisting condition issue for those over 65 and purchasing Medigaps outside the six month period when they first become eligible for Medicare. Annual open enrollment after that is NO GUARANTEE you can switch. So, it is important to choose carefully.
Once enrolled in Medicare and/or a Medigap/MA, any change during annual open enrollment will require you complete a health questionnaire. Many people are denied when trying to switch or upgrade. Annual "open enrollment" is not a get-out-of-jail free card. Annual open enrollment allows you the ability to try to switch but DOES NOT GUARANTEE you can do so. It all depends on your health.
Fwiw, even though I have no health issues, I dropped my free Advantage plan and moved to the hd-F for that exact reason. I wanted to switch while I had NO health issues because once problems developed, I might not find a plan to accept me.
If cost is an issue, consider the high-deductible Medigap F plan. This has already been suggested upthread. You could potentially be responsible for the 20%/excess which Medicare does not pay up to $2,140 in any one year, but after that you're home free. My hd-F premium is $76/mo. at age 72. Yours should be less because you are younger, although NY could be higher. I'd have to doctor a lot and/or be hospitalized to meet that deductible. But, the hd-F does cap my annual out-of-pocket at that amount. So, I consider the $76/mo. a cya for worst-case scenario.
Many people feel the hd-Fs are a really great deal. You're not stuck with a $150/$175/mo payment month in and month out, but still have all the flexibility of a Medigap and a reasonable cap on expenses should the worst occur.
Last edited by Ariadne22; 05-17-2014 at 02:28 PM..
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