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I'm not totally clear on this...... but it seems medicare part C cripples part AB in some ways, right?
If you only have part A/B, you can directly see any doctor or specialist in the USA who accepts medicare.
But if you sign up for part C, you must go through a primary doctor like in an HMO.
Also, if you see a doctor outside your county/city boundaries, you are not covered for medical expenses unless it's urgent or an emergency.
Here's where I'm scratching my head.
Part C is supposed to provide all of the benefits of part AB.
But,
with part AB alone, you can see any doctor in the country and you're covered.
with part C, you're only covered in your service area (county/city where you reside)
How is this equivalent to part AB? It seems you get less than part AB.
Not all Part C - Medicare Advantage plans - are HMOs.
If you do not want limitations of an HMO, enroll in a Medicare Advantage Plan which is a PPO or PFFS. You will pay somewhat more.
Know that in a PPO, if you see a doctor outside the PPO network, the MA will pay, but your coinsurance will be much higher.
Which is why MA's have max out-of-pockets of up to $8k in some areas.
If you want to avoid this, buy a Medigap G or F, plus a Part D, and most of your expenses will be paid w/exception of drug copays - ANYWHERE IN THE COUNTRY. Of course, the Medigap premium is not zero or even close to zero. Depending on your age and where you live, your premiums for Medigap & Part D will be about $200/mo. A whole heck of a lot better than an exposure to $8k. Of course, if you're never sick, you may not want to pay $200/mo.
Alternative is a high-deductible Medigap F, plus a Part D plan. Read this thread:
If you MUST have an MA, compromise and pay some premium, and enroll in a PPO or PFFS. Avoid the HMO's. They present REAL problems when you travel should you encounter a serious illness and lengthy recovery outside your service area.
We had a case here in WI this past January involving UHC MA which was an HMO. Patient apparently didn't know if he got sick in TX, the UHC HMO would not pay for rehab out-of-network. This is a man who wintered every year in TX. He should NEVER have had an HMO. He had emergency heart surgery in TX for which UHC did pay, but UHC refused payment for rehab. UHC insisted he return to WI. Only way he could do that was on a private aircraft for $20k. Commercial aircraft wouldn't take him.
Essentially, you get what you pay for with an MA - biggest issues can be lack of flexibility of providers and denial of services - even routine, in-network servicees. Happens all the time.
MA plans are run by profit-oriented private insurers. Their first priority is to make money. Their second priority is to provide Medicare benefits. Read this for brief overview of how MA's make their money:
FYI - you are in CA. People here on Kaiser MA's are generally pleased with them. Reason is Kaiser owns its own facilities and employs its own docs, so denials and nonpayment of services is not an issue - as all fees are kept in-house. However, out-of-network will be. I don't believe Kaiser runs any PPOs in California, but am not certain about that.
Last edited by Ariadne22; 06-24-2015 at 04:36 PM..
Not all Part C - Medicare Advantage plans - are HMOs.
If you do not want limitations of an HMO, enroll in a Medicare Advantage Plan which is a PPO or PFFS. You will pay somewhat more.
...
MA plans are run by profit-oriented private insurers. Their first priority is to make money. Their second priority is to provide Medicare benefits.
...
FYI - you are in CA. People here on Kaiser MA's are generally pleased with them. Reason is Kaiser owns its own facilities and employs its own docs, so denials and nonpayment of services is not an issue - as all fees are kept in-house. However, out-of-network will be. I don't believe Kaiser runs any PPOs in California, but am not certain about that.
Errr...not to hijack, but what kind of plan should I get (when it's time) if I want to eliminate geographic constraints?
I have this fond fantasy of doing the Grand RV Tour of National Parks. It would be the perfect segue into retirement, and I've always wanted to go see them. I'd like to get the kind of plan that will let me do that without being concerned about medical care should I get a bear hug, lol!
I went on medicare.gov and there are no more PPO MA's in this zip code.
supposedly they all lost money, so all we are left with are HMO's.
My dad is leaning toward part D, which definitely looks better.
Part D only covers his drugs - with copays.
If he wants the 20% not paid by Part B and excess charges covered for places like Mayo, MD Anderson, he needs a Medigap. If he encounters a serious health issue, he will regret not being covered.
Also, fyi, Medigaps cover the hospital deductible, 365 extra lifetime hospital days beyond what Medicare pays for, 365 home health visits annually, additional skilled nursing copays, excess charges for nonparticipating places like Mayo, MD Anderson which can increase that copay from 20% to 30%.
One can also buy cost-sharing Medigaps for a lower premium than G/F which cap max-out-pocket - but still allow complete flexibility of provider. Read this:
Again, not sure what his financial situation is but, if he is reasonably healthy and doesn't expect a lot of medical care in the near future, he should seriously consider a high-deductible Medigap F. They are very inexpensive - about $50-$70/mo. He can see any Medicare provider anywhere in the country.
Essentially, Medicare pays its 80%. Your dad is responsible for the remaining 20% up to the deductible of $2,180; thereafter Medigap pays, plus all the add'l features I mentioned above. It is, essentially, catastrophic Medicare coverage.
The 20% Medicare doesn't pay is usually not a significant amount - UNTIL one gets seriously ill. Then it can become a problem, especially with multiple hospitalizations which are subject to deductible for each admission not within the "benefit period."
FYI - I have an hd-F. Never doctor for anything, don't take medication. But, should something awful happen, I can see any provider anywhere which accepts Medicare patients and, in any one year, my exposure for Medicare-approved charges is limited to the premium plus the deductible.
Quote:
Originally Posted by oh come on!
My only gripe is that they say MA is supposed to provide all the benefits of parts AB, and that's a lie.
If my dad ever wanted to go to Cleveland Clinic for treatment, part C doesn't cover it.
If he only had part AB though.... he would be covered.
"all the benefits of A/B" my ass
Correct. "All the benefits of A/B with important restrictions" is more accurate.
Last edited by Ariadne22; 06-24-2015 at 06:56 PM..
Errr...not to hijack, but what kind of plan should I get (when it's time) if I want to eliminate geographic constraints?
I have this fond fantasy of doing the Grand RV Tour of National Parks.
You get a Medigap - either a full Medigap or high-deductible Medigap F as discussed above. Megaps do provide complete doctor/provider flexibility. Various options, listed here.
Contact your senior center for help in choosing a plan. Most states provide help in navigating the Medicare options through what is called a SHIP program.
Last edited by Ariadne22; 06-24-2015 at 06:42 PM..
HOW ON EARTH are people expected to understand these choices?? I have no idea why it got to the point where Seniors (for the most part) are supposed to understand and wade through way too many choices - WHO/WHAT admin. decided this? - People shouldn't have to spend hours (and have internet access and understand how to use it) - to wade through.
Sorry, a rant - Ariadne seems very knowledgeable and I admire that - but for "regular" folks - what is the option? (My Mom lives a 6 hr. drive from me and isn't aware of any help navigating) - I've tried to help over the phone, etc. - but I don't understand myself and I was a benefits admin. before I had to take disability!
I'm concerned as I am eligible for Medicare 2 yrs. after disability determination - and will prob. have to wade through all this crap - if someone is a senior and/or disabled w/whatever condition - maybe doesn't even have a computer..... it's assanine!
I'm not totally clear on this...... but it seems medicare part C cripples part AB in some ways, right?
If you only have part A/B, you can directly see any doctor or specialist in the USA who accepts medicare.
But if you sign up for part C, you must go through a primary doctor like in an HMO.
Also, if you see a doctor outside your county/city boundaries, you are not covered for medical expenses unless it's urgent or an emergency.
Here's where I'm scratching my head.
Part C is supposed to provide all of the benefits of part AB.
But,
with part AB alone, you can see any doctor in the country and you're covered.
with part C, you're only covered in your service area (county/city where you reside)
How is this equivalent to part AB? It seems you get less than part AB.
Well, in some large metro areas Advantage plans are popular, widely accepted and have large networks.
Be aware though that if you live in a rural area or in smaller cities (or towns) Advantage plans are likely not for you. If you are planning on doing a lot of travel, forget them.
Also, check with your doctor/local hospital to be sure they accept these plan if you decide to go this route.
And generally, skip United Healthcare (AARP) and Humana.
HOW ON EARTH are people expected to understand these choices??
I have no idea why it got to the point where Seniors (for the most part) are supposed to understand and wade through way too many choices
Essentially, flamingo, it comes down to money and where you live.
Anyone rural shouldn't be in an Advantage plan - providers are generally very scarce to nonexistent.
The majority of people choose Medicare Advantage Plans (essentially managed care) because most plans include drugs and the premiums are very low, some as low as zero. Complications arise because of limited provider networks, and gatekeeping/approvals on services, especially for the chronically ill.
If you have a reasonably comfortable retirement income, choose a Medigap G or F (or hd-F), and a Part D if you take medication.
Since you are in Virginia, here is info on SHIP help in your state - all I did was google Virginia SHIP program:
I'm concerned as I am eligible for Medicare 2 yrs. after disability determination
If you are on SSDI and going on Medicare before age 65, then your choices will be more more limited - and they will be more expensive - until you reach age 65 based on posts from others on SSDI looking for a Medigap/Medicare Advantage before age 65. However, if you are now on SSDI w/Medicaid, addition of Medicare shouldn't change anything. What happens is Medicaid pays what Medicare doesn't. You don't need a Medigap. If that is not your situation, hopefully, in your case, SHIP will prove to be helpful in finding appropriate coverage for your situation.
Last edited by Ariadne22; 06-24-2015 at 08:08 PM..
I went on medicare.gov and there are no more PPO MA's in this zip code.
supposedly they all lost money, so all we are left with are HMO's.
My dad is leaning toward part D, which definitely looks better.
My only gripe is that they say MA is supposed to provide all the benefits of parts AB, and that's a lie.
If my dad ever wanted to go to Cleveland Clinic for treatment, part C doesn't cover it.
If he only had part AB though.... he would be covered.
"all the benefits of A/B" my ass
Going with just A/B alone will be VERY expensive if he doctors a lot or ends up in the hospital. Personally, I would never go with a MA plan, and you are correct, is is next to impossible to find a PPO MA plan any more unless it is a retiree group plan. There are older plans that people have that are PPO's but finding new plans is difficult. He needs to look at the Supplement plans. They are more expensive but you can go to anyone that accepts Medicare and your out of pocket costs are little to nothing.
Quote:
Originally Posted by Flamingo13
HOW ON EARTH are people expected to understand these choices?? I have no idea why it got to the point where Seniors (for the most part) are supposed to understand and wade through way too many choices - WHO/WHAT admin. decided this? - People shouldn't have to spend hours (and have internet access and understand how to use it) - to wade through.
Sorry, a rant - Ariadne seems very knowledgeable and I admire that - but for "regular" folks - what is the option? (My Mom lives a 6 hr. drive from me and isn't aware of any help navigating) - I've tried to help over the phone, etc. - but I don't understand myself and I was a benefits admin. before I had to take disability!
I'm concerned as I am eligible for Medicare 2 yrs. after disability determination - and will prob. have to wade through all this crap - if someone is a senior and/or disabled w/whatever condition - maybe doesn't even have a computer..... it's assanine!
I agree!!! I don't know that they could have made this more complicated. I'd suggest checking with a local senior center and see if they can recommend a GOOD Medicare broker in your area. They will be able to walk you through all of the eligibility periods, the plan types, etc. You do not pay them anything, their commission is already worked into the premiums whether you use a broker or not, so might as well use one. If you don't have a senior center near you, ask friends, people from your church, etc. There are pretty strict regulations on Medicare brokers, but that doesn't mean they are all good.
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