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Old 05-31-2014, 11:04 AM
 
1,338 posts, read 3,496,200 times
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Hello,

I have to make the Medicare decision soon... at times it seems straightforward and at others overwhelming.

I start out with a low opinion of any Medicare Advantage plan because I had a hard time when them when my mom was alive and we were getting (or trying to get) her services. All I ever heard was "we won't get paid, we won't get paid." Our (company's) insurance broker also feels Advantage plans may get phased out/down, but he is an Obamaphobe anyway so I don't know if that's a valid future concern, should I want to revisit MA choices.

So my first inclination is to go with Original Medicare and a MediGap plan.
When I got my mom back on Original Medicare I got her an AARP medigap and they seemed to be decent in terms of claims and payments.
I am in Texas (Houston metro) and our broker agent recommends Blue Cross/Blue Shield, Plan F or high-deductible Plan F. I find the alphabet soup of Medigap plans puzzling... some premiums outright seem to be higher for less coverage, so why would someone choose them? In my area I could get the Plan F Hi-D for $49 a month, (can't find the chart at this second but deductible is around $2300); regular F $100 more. I haven't checked Drug plans yet but it's not a big concern as I only take one scrip and it's not costly.

I feel that I don't know what I don't know... are there things I'm not considering? I'm hoping to get a small "windfall" in my paycheck because our current insurance takes nearly $600 a month out of my pay... but as I say, there may be things I'm not accounting for?

Any insight/experiences appreciated! And if you love your plan (and carrier) please say why?

Thanks!
;
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Old 05-31-2014, 12:43 PM
 
Location: Glenbogle
730 posts, read 1,028,032 times
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I too am trying to balance the pros and cons of getting a Plan F, a hi-D Plan F, or a Plan N.

In my area (Long Island, NY) AARP/UnitedHC is by far the cheapest as far as premiums, compared to the other companies; but they are by no means "cheap". Their Plan F is $261/mo and Plan N is $179. They do not offer a hi-D plan F in my area.

There are only a couple of carriers who offer hi-D Plan Fs; the two cheapest are $64/mo and $96/mo. Their rates for the other plans are higher than AARP's though.

Much of my past (and probably future) medical expenses are for testing: MRIs with contrast, CAT scans, PET scans and X-rays. I'm somewhat leaning toward a Plan N, only because the copays with that plan might not apply to the diagnosis codes for such tests (they would apply to office visits). The thing is, if I were to get one of the hi-D plan Fs, I would be saving about $200/month in premiums (compared to a regular plan F) which is $2400/yr. But I would be responsible for the first $2140 which ... if something comes up that will require a lot of expensive testing in any one year... would not save me all that much for that particular year.

Have you tried asking your current doctors etc to tell you what your 20% would be for the kind of things you usually get, i.e. office visits etc? This might help you to decide how much of a 'gamble' the hi-D plan would be for you. I tried asking mine but only one would tell me. I asked the radiology office the same question and had better luck; the billing supervisor said that a lumbar spine MRI (without contrast) which is something commonly done if the patience has lower back pain, has a Medicare approved fee of $294. I was shocked because I had one several years ago and had to pay for it out of pocket; it was about $600 even then. But at the Medicare price of $265, if I didn't have a Medigap I would have to pay only about $60 (or if I had a hi-D plan F, that $60 would count toward my deductible). However, the MRI with contrast costs at least a couple hundred dollars more.

She did say that Medicare has cut reimbursements and that they used to get more from Medicare for everything they do. This is good news for people who don't have a supplement plan, or who have a high-D plan, I guess!!

What are the premiums for a Plan N in your area? That might be a good compromise for you. You'd be responsible for the Part B deductible and for a copay of no more than $20 for most office visits but it sounds like you might come out better that way than having to pay the first $2140 of all expenses each year.
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Old 05-31-2014, 12:53 PM
 
Location: Bella Vista, Ark
72,014 posts, read 83,671,479 times
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We live in AR and have medicare advantage plan. I can't say enough positive things about it. We have top doctors (yes, we do have good medical care in Ar) we have had very few problems with rejection of anything, including months of cancer treatments for my husband and we had good luck with a similar plan in NM, but here it is better. We have Humana. You might want to give it a try. Yes, we pay co payments but we would rather do that than pay the premiums some of our friends are paying for no better coverage. And they have some co pays as well, just not quite as much as we do.
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Old 05-31-2014, 12:55 PM
 
Location: Wisconsin
21,541 posts, read 44,039,638 times
Reputation: 15150
Quote:
Originally Posted by catfancier View Post
I feel that I don't know what I don't know... are there things I'm not considering? I'm hoping to get a small "windfall" in my paycheck because our current insurance takes nearly $600 a month out of my pay... but as I say, there may be things I'm not accounting for?
No, you're not overlooking anything - and I agree with everything you've said about MAs and the cost-sharing Medigaps. We've beat this issue to death on this board, many times.

Your agent is correct. Very simple. If you're healthy, hd-F is the way to go. 2014 deductible is $2,140. I have an hd-F. If you have or anticipate health issues, buy the full Medigap F or G. G doesn't cover Part B deductible of $147, but that's the only difference.

Some people on very tight budgets choose one of the alphabet soup plans because they are counting every $10 and the difference in premium is important. Usually, they're doing a cost-benefit analysis on anticipated medical expenses, copays v. premium outlay.

I'm very healthy and view the issue the same way you do - I've never seen the point to cost-sharing Medigaps, as they are fairly high priced and a couple of them don't have caps on out-of-pockets. If you're going to cost share, may has well go w/an hd-F, imo. You know your monthly premium, you know you could potentially be responsible for $2,140 in any given year. After that, you're home free.

I switched from a UHC Advantage plan to an hd-F - because of type of issues you had with your mother - two minor experiences were enough for me. I don't want those hassles plus potential provider network issues. Most MAs are HMOs, or soon will be, which restricts doctor choice. My UHC started out as a PPO/POS, now is an HMO. UHC cutting provider networks nationwide. I don't trust MAs.

Only two companies offer hd-F's in WI - American Republic and Physicians Mutual. I am 72, paying $76/mo. through Physicians Mutual Had I bought a BCBS plan a year ago, premium would be $65/mo. BCBS no longer offering hd-F in WI, for now. If they get back in the market, I may switch.

Go with an hd-F or a full-blown F or G. End of story. It's really very simple.

Last edited by Ariadne22; 05-31-2014 at 01:21 PM..
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Old 05-31-2014, 01:03 PM
 
Location: Wisconsin
21,541 posts, read 44,039,638 times
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Quote:
Originally Posted by nmnita View Post
We live in AR and have medicare advantage plan. I can't say enough positive things about it. We have top doctors (yes, we do have good medical care in Ar) we have had very few problems with rejection of anything, including months of cancer treatments for my husband and we had good luck with a similar plan in NM, but here it is better. We have Humana. You might want to give it a try. Yes, we pay co payments but we would rather do that than pay the premiums some of our friends are paying for no better coverage. And they have some co pays as well, just not quite as much as we do.
Humana is one of the worst generally, nationwide. Your experience is not universal. Here is just one complaint - State of Minnesota AG filed w/Medicare:

Minnesota attorney general asks U.S. to investigate Humana | Star Tribune

If I were seriously ill, I would never have an Advantage plan - and left a zero-premium MA because of the trouble I had with UHC on payment for two very simple office visits. CS a nightmare, they play games on the paperwork. Very bad. Humana the same from what I read and what my sister, a nurse, says about them.

I have always been puzzled, however. why these issues are so state-specific, because claims processing is pretty much centralized for these huge companies.

I would caution anyone who is not counting their pennies to avoid MAs, and Humana and UHC, in particular. There other MAs - not as large which may provide reliable service. Region does matter.

For anyone considering an MA, best to talk to the providers in your area as to which carriers are the best and worst.

For me, the two totally unnecessary issues I had on simple payments were enough for me. Plus, some of these MAs are cutting their provider networks.

I don't like MAs. They are all about THEIR bottom line. I would never want to be seriously ill and have to go through a gatekeeper before receiving treatment.

Last edited by Ariadne22; 05-31-2014 at 01:20 PM..
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Old 05-31-2014, 04:00 PM
 
Location: Wisconsin
21,541 posts, read 44,039,638 times
Reputation: 15150
Quote:
Originally Posted by StressedOutNYer View Post
What are the premiums for a Plan N in your area? That might be a good compromise for you. You'd be responsible for the Part B deductible and for a copay of no more than $20 for most office visits but it sounds like you might come out better that way than having to pay the first $2140 of all expenses each year.
OP should know Plan N has no cap on out out-of-pocket expenses and it doesn't cover Medicare nonparticipating provider excess charges - which can be very common in more affuent areas, among specialists, or high-end nonparticipating medical facilities such as Mayo. OP would need to query TX facilities she might use, such as MD Anderson or Baylor. Even then, the docs or other providers on staff may be nonparticipating even if the hospital is participating.

Costs & assignment | Medicare.gov

Compare Medigap policies | Medicare.gov

OP would need to be prepared for those unexpected charges when they occur - or, if this is an issue, limit her providers to Medicare participating providers only.
.
.

Last edited by Ariadne22; 05-31-2014 at 04:10 PM..
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Old 05-31-2014, 07:31 PM
 
Location: Chesapeake Bay
6,048 posts, read 3,874,457 times
Reputation: 3502
Some of the Medicare Advantage plans are very good. But the two largest, Humana and UHC, generally have miserable reputations and deservedly so based on the large number of complaints re them.

Since they are the largest providers they sometimes do give Advantage plans a poor reputation, I really don't understand why Medicare puts up with them. Medicare could end their poor service and the billing games they play today if they wished. Maybe Medicare is depending on their star rating system to eventually force these two companies to do better?

But so far they continue on with their shoddy products. One would think that word of their poor reputation would get around the country. I got a Humana Advantage plan circular just this week which I trashed.
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Old 05-31-2014, 08:40 PM
 
Location: High Cotton
6,131 posts, read 6,445,243 times
Reputation: 3657
Choosing a High-Duductible Plan F (for $49 versus $149 for a regular Plan F with BC/BS of Texas for example) is a very smart decision for anyone that doesn't have a tremendous amount of annual medical needs. The $1,200 annual savings difference (between the H-D F vs. the regular F) is a no-brainer for all but people that have tens of thousands of dollars in medical bills each year. Do the math by looking at the maximum deductible you would have to pay 'if' maximum medical needs were in your future one year, and then reduce that [potential] paid-out deductible amount by the $1,200 in annual savings that you did not have to pay. Remember, the Medigap plan you choose is just insurance against the 20% gap that Medicare doesn't pay, so your [high] deductible you may [potentially] have to pay when choosing the H-D Plan F is only for 20% gap.

PS - I personally would NEVER choose to go with a Medicare Advantage plan.
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Old 05-31-2014, 09:34 PM
 
Location: Chesapeake Bay
6,048 posts, read 3,874,457 times
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Quote:
Originally Posted by highcotton View Post

PS - I personally would NEVER choose to go with a Medicare Advantage plan.
Depends on location/carrier. In many places they are the plan of choice.
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Old 05-31-2014, 09:54 PM
 
Location: Mostly in my head
19,828 posts, read 56,039,834 times
Reputation: 19025
When I was close to 65, I asked a friend who worked in a large hospital as a LCSW doing discharge planning what would be best. Her opinion was that the MA plans were good for those who did NOT have a chronic condition. If you have a chronic condition, get straight old Medicare with a supplement. I did and have been just fine fi r 7 yrs.
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