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What is the difference? Which one should I get? I begin Medicare in November and live in Pennsylvania. I know I need to purchase Plans B and D and want a PPO. So far, I have checked IBX, Humana and United through AARP. I would appreciate comments about the good or bad of these companies and another recommendations. One of the drugs I take is Enoxaparin. It is very expensive and I will reach the donut hole after two months. Which online prescription companies offer the best prices?
I know I'm asking a lot of questions, but this is very confusing. Thank you so much.
You can start by looking at the other recent Medicare/vs/Medigap threads on here. I just went on Medicare in June and wish I would have gotten a Medigap type supplement rather than a Medicare Advantage plan. The MA plan already denied one of my providers even though he was listed in their network, citing some arbitrary and archaic rule. I also take very expensive meds and so I understand your concerns there. You can go online at Medicare.gov, plug in your meds, and then shop for various plans for your geographic area. Be sure to look at the detailed information in the benefits section-not just the overview. I have heard very bad things about Humana from my providers and others here, FYI.
I qualify for Social Security "extra help" in paying for meds and I would encourage you to apply. They subtract off alot of stuff so you dont have to be destitute to receive some discount on your prescriptions. I would apply now for that if I were you, and you will then know what your costs will be in relation to meds when you are shopping for plans. Go to Social Security.gov to apply.
I also checked around for prescription assistance plans, and two of the companies actually allow you to have insurance and still qualify for copay help. Most dont allow you to receive help if you are on Medicare, but two of mine did. So look around and google "prescription assistance" and the name of your meds, one at a time.
One website I found valuable is goodRX. You can check prescription costs within a certain radius of your home. I transferred all my prescriptions to Walmart instead of Walgreens, because they were 20-100 dollars cheaper at Walmart. Prices, Coupons and Information - GoodRx FYI-for the plans in my area--the mail order prescription companies were NOT cheaper.
On the plans, YMMV in each state. You can get help from your area agency on aging. Google "area agency on aging" and your state name, and you will find alot of comparison help if you talk with them.
What is the difference? Which one should I get? I begin Medicare in November and live in Pennsylvania. I know I need to purchase Plans B and D and want a PPO. So far, I have checked IBX, Humana and United through AARP. I would appreciate comments about the good or bad of these companies and another recommendations. One of the drugs I take is Enoxaparin. It is very expensive and I will reach the donut hole after two months. Which online prescription companies offer the best prices?
Advantage plans are usually less expensive, but can be problematic as to networks and gatekeeping/approval. More and more are converting to HMO and removing the PPO feature. Especially avoid Humana and United Health Care MA's. Both will give you serious grief if you run into any ongoing health issues.
OTOH, the AARP UHC Medigap is fine. I would assume a Humana Medigap is also fine. Medigaps MUST pay the 20%/excess that Medicare doesn't pay and have no rights of approval on treatment or payment of any Medicare-approved charge - whereas they are serious gatekeepers on approval and payment for their MA benefits.
A recent post which most of us, here, pretty much agree with:
Quote:
Originally Posted by ocnjgirl
The vast majority of Medicare Advantage plans are state-specific, you can't even use them outside your state let alone the country. My Mom had Blue Cross of Pa plan, and when I brought her here to NJ (she was being D/C'd from rehab and couldn't return home alone) her plan paid for nothing here. We had to pay out of pocket for her to get a physical for ALF placement, no reimbursement. From the minute she set foot in NJ, she basically was uninsured until I could get her disenrolled from Pa to NJ Blue Cross (they are run completely separately, you can't switch just from one to the other) and it took weeks to complete the change. She would have been covered for ER only in NJ under the Pa Blue Cross Plan.
As a rehab therapist who's worked in geriatric health care for 18 years, I would scrimp so I could get traditional Medicare and a supplemental. If you ever get sick or need rehab, your co-pays are going to be astronomical with any HMO Medicare plan, and your choices of places to go for rehab may be limited as well. You will also have to get re-approved for rehab every few days to a week, while under traditional with a supplemental, you can get up to 100 days of rehab after a 3-day hospitalization (as long as you're still making progress and have goals you haven't met yet). My Mom had about $7000 total co-pays for that illness, including ambulance, hospital and rehab (about 2-3 weeks). I switched her to traditional as soon as open enrollment came, and now if she had the same illness and went to the same rehab, she'd have zero in co-pays. She thought her plan was great, no premiums, what could be better??
Better is a plan that covers everything, and without begging (her plan wanted to cut her after the first week, even though she couldn't walk by herself yet but had been living alone independently prior to getting sick).
My recommendation is a high-deductible F Medigap with a good Part D for your specific drug needs. Use the Part D tool on the medicare.gov site to determine which Part D plan is best for you. If you have a lot of serious health issues which require a lot of care, then a full Medigap - depending on premium cost - along with a Part D - might be more appropriate - but you really need to run the numbers. Even then, a high-deductible F might be much more cost effective. See, especially last two pages:
I ended up with a Medigap G Plan. It starts in November and I'm paying $136.17 a month. Now, I need to find a drug plan. So far, Humana Rx seems best for me.
Thanks for that update. $136/mo. is reasonable. Can't get a Medigap F/G in WI for anything less than $225/mo. Area really does matter.
Medicare avantage plans vary by state. In Florida there are allot to choose from. Im on a advantage plan and all I pay is $18.00 a month because I'm on a special needs plan. I have had no problem with my plan. There is a large network of doctors to choose from. I only pay $20 to see a specialist. The part d is also great i use their mail order and i pay $0 for generics, and $25 for peered. I get 90 day supply , and when i use their mail order i only pay $50 of a 90 day supply of their tier 2 drugs I get a month free.
Medicare avantage plans vary by state. In Florida there are allot to choose from. Im on a advantage plan and all I pay is $18.00 a month because I'm on a special needs plan. I have had no problem with my plan. There is a large network of doctors to choose from. I only pay $20 to see a specialist. The part d is also great i use their mail order and i pay $0 for generics, and $25 for peered. I get 90 day supply , and when i use their mail order i only pay $50 of a 90 day supply of their tier 2 drugs I get a month free.
Tell us the name if your insurance company, also, please. Humana, UHC, what???? It would be good for everyone here to know, specifically, the names of MA's that actually do what they say they will do. More and more these 'good' MA plans are becoming the exception.
The insurance company makes a HUGE difference when it comes to satisfaction with MAs.
Also your copays are very low copays. Specialist copays in my area at least $40, in some plans $50. And you have no trouble getting your scrips filled - which is also not true for some plans - especially the bigger ones.
Advantage plans also vary by zipcode within a state. I was on an MA in Milwaukee County area and could not use the plan out of my four-county area in my state - not even in Northern WI where our family has a lake place. MAs can be very restrictive - except for ER. When one is spending the entire summer in Northern WI - a medical plan good for ERs only isn't particularly helpful if one needs ongoing care. Not my situation, but nonetheless very restrictive.
Tell us the name if your insurance company, also, please. Humana, UHC, what???? It would be good for everyone here to know, specifically, the names of MA's that actually do what they say they will do. More and more these 'good' MA plans are becoming the exception.
The insurance company makes a HUGE difference when it comes to satisfaction with MAs.
Also your copays are very low copays. Specialist copays in my area at least $40, in some plans $50. And you have no trouble getting your scrips filled - which is also not true for some plans - especially the bigger ones.
Advantage plans also vary by zipcode within a state. I was on an MA in Milwaukee County area and could not use the plan out of my four-county area in my state - not even in Northern WI where our family has a lake place. MAs can be very restrictive - except for ER. When one is spending the entire summer in Northern WI - a medical plan good for ERs only isn't particularly helpful if one needs ongoing care. Not my situation, but nonetheless very restrictive.
I live in Pinellac county Florida my Medicare avantage plan is through Optimum healthcare. Florida as you know is the retirement Capitol of the country, so there are many different medicare avantage plans here.
We live in AR but used to live in NM> In both places we choose M Advantage and are satisfied, more so here than before. Yes, we have to use their doctors or go out of the system and pay more, yes, we pay do pays, but our doctor choices are top of the line and we have rarely been tuned down for anything. I know when hubby was dealing with cancer if it wasn't for M. Advantage we would be on welfare by now. The only extra we pay is for dental and eyes. It costs us each $20 a month. We have Humana.
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My Medicare avantage plan
