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Old 05-12-2017, 09:14 PM
 
32,541 posts, read 51,077,194 times
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My husband and I are both over 65--have been on Medicare original since we turned 65 with our supplemental insurance and RX coverage through my retired teacher state insurance plan--that we were on as primary coverage before we turned 65...

Now my state's health plan for working educators and retired members is going through big upheaval because our state (Texas) has failed to fund ITS portion of the health care fund for decades...
The state employees' health care plan is not tied to the teachers' plan--and it has much better coverage and lower premiums from what I have read via a teachers' website because it has gotten the funding from the legislature through the budget process over the years--that insurance plan/ fund is what the legislators use when they retire...just as Congress takes care of its health care needs usually better than regular voters'...

If the state doesn't make the necessary contribution, all retirees eligible for A and B will be forced out of our plan and required to get a Medigap plan to go with Medicare and then a RX/Part D plan--with the donut hole.

IF the state legislature commits to like a 600 million payment for this 2 yr budget cycle (much less than needed and much less than what is owed) those over 65 eligible for Medicare A and B will be forced out of the TRSCare plan as a Medigap suppliment and forced into Medicare Advantage....run via Human...
Aetna used to run it but guess they stunk so badly the organization went to Humana

SOME teachers because they never paid in SS/Medicare don't have enough credits to be eligible for Medicare and I don't know what they will do...most of them do not have any real pension because they are older and were not highly paid administrators in bigger districts---I think the plan is the state will pay them off and expect them to buy their own coverage...but the state won't pay them nearly what it will take to buy a decent policy--especially if they have any pre-existing conditions...

So my husband and I likely will have options of either Humana Advantage coverage or search out a supplemental Medigap plan and a Part D RX plan
The only decent aspect of the Humana Advantage is that apparently our Part D coverage would still go through the TRSCare prescription coverage which would mean no donut hole--
My husband takes quite a few RX and when he was first going into Medicare I checked how his drugs would work with a Plan D--and he hit the donut hole with every option--some worse than others...

Another thing--we travel to FL and stay for 8 wks or so at a time--have second home there
Most doctors/hospitals in FL hate Advantage plans
How does Humana ADvantage treat out of network care???
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Old 05-12-2017, 10:31 PM
 
Location: Wisconsin
23,553 posts, read 50,162,029 times
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If you travel, a PPO Advantage plan through Humana may should be all right. Others here in TX have them and say they function properly. Networks and oversight on treatment for ongoing care are the biggest issue with MA's.

If you don't have serious health issues, a high-deductible F Medigap will allow complete provider flexibility at a very low cost. Many people on CD have hd-Fs. Premiums in your state are not high - Medicare still pays its 80%, you pay 20% and/or Part A deductible up to $2,200, thereafter plan pays 100%. Standard Life & Accident in TX is one insurer you should contact. Rates are reasonable, usually about one-third to one-half the cost of a regular Medigap, very responsive customer service when I communicated with them a few years ago. Discussion on hd-Fs, here:

Help - In Texas: Thinking Original Medicare and hi-D Plan F - thoughts?

For your co-workers who don't have sufficient Medicare credits, they can still buy into Medicare, but it is costly.

https://www.medicare.gov/your-medica...#collapse-4808

For those losing existing coverage, a guaranteed issue period begins during which there would be no health underwriting required if they choose to get another Medigap.

https://www.medicare.gov/find-a-plan...otections.aspx

Last edited by Ariadne22; 05-12-2017 at 10:54 PM..
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Old 05-13-2017, 04:35 PM
 
Location: Manhattan Beach
4 posts, read 3,185 times
Reputation: 15
Regarding your fellow teachers that don't have enough work history to qualify for Medicare, they may be able to qualify based on their spouse's (or ex-spouse's) work record. They can qualify for premium-free Medicare Part A at 65 as long as their spouse is 62 or older, or is younger than 62 and is receiving disability benefits, and has 40 quarters of qualifying work history. If they're divorced and were married for 10 or more years, they can claim Medicare benefits from their ex with these exact same rules.

If you get an Advantage plan, they will cover you in Florida just as if you were in-network any time you need emergency care. These plans often cover urgent care situations the same way. Outside of these situations, you'll probably find a lot of restrictions, and increased cost-sharing amounts being out-of-network . If you go this route, it'll probably be best for you to plan on getting all your necessary visits, treatments, etc. done back home in-network either before or after your Florida trips.

Keep in mind the donut hole is set to go away in 2020. Each year from now til then, your copay percentage is decreasing for both brand name and generic drugs. It might make sense for you to stay with the Humana Advantage plan at first, but not 2 or 3 years down the road. It'll definitely pay to reconsider your options each year.
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Old 05-13-2017, 06:13 PM
 
Location: Wisconsin
23,553 posts, read 50,162,029 times
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i
Quote:
Originally Posted by Christopher J. Russo View Post
If you get an Advantage plan, they will cover you in Florida just as if you were in-network any time you need emergency care. These plans often cover urgent care situations the same way. Outside of these situations, you'll probably find a lot of restrictions, and increased cost-sharing amounts being out-of-network . If you go this route, it'll probably be best for you to plan on getting all your necessary visits, treatments, etc. done back home in-network either before or after your Florida trips.
This is why the only Advantage plan OP should consider is a PPO. An HMO will present all manner of problems if either OP or hubby require ongoing care for a chronic condition while in FL.

Quote:
Originally Posted by Christopher J. Russo View Post
Keep in mind the donut hole is set to go away in 2020.
I wouldn't count on that. Elimination of the donut hole is part of the ACA. GOP is on a mission to repeal the ACA. If the AHCA is passed, the donut hole could very well be resurrected, as well.

Last edited by Ariadne22; 05-13-2017 at 06:40 PM..
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Old 09-20-2017, 09:36 AM
 
32,541 posts, read 51,077,194 times
Reputation: 18422
Default My private/retiree supplemental Medicare/gap policy being phased out--??

I am retired teacher w/state of TX--
I have Medicare A/B because of my own earnings and have paid out of my retirement check for the best level of health insurance offered through my Texas Teacher Retirement system--

My husband is also on my policy--he had insurance through his work prior to retirement--now he has Medicare and my teacher's insurance as his Medigap coverage--
We have drug coverage through this insurance so pay no Part D monthly fee and have no donut hole through this plan which WOULD happen for my husband if we were on conventional Plan D coverage

We have had some high income which made our Medicare premiums fall into the surcharge area--
And IF we had been paying Part D we would have paid surcharge for those premiums too I believe--
Our coverage via the teachers' insurance is a covered plan--meaning we can switch to other Medicare/Medigap policies and not suffer penalties...

For variety of reasons my teacher insurance coverage will automatically default in Jan 18 for ALL Medicare eligible retirees and any spouses on that program to a Humana Advantage plan--
Supposedly this Humana plan is not the same as a general Humana Medigap policy available to public at large in various states because it will pay ANY doctor you use if they will file...
Also I think our RX needs will still run through this plan w/o a donut hole--but I have had trouble finding out if that is accurate info
If so I think we will not pay a separate Plan D monthly premium--we don't pay any now--
my husband has deferred his SS annuity til 70 which happens in Dec--
so he has been paying his Medicare premiums quarterly--
mine since I started receiving spousal SS are deducted from my SS check...

I have signed up for a group seminar about this new change to be held in October
I want to know the BEST questions to ask at that meeting (if the info provided doesn't cover our specific situations)..so coming here to get some specific suggestions
Part of our situation is complicated because we have second home in FL and spend about half the year there in 6-10 week segments--and we have had to see doctors during those times==
Many doctors/hospitals will not treat anyone with an Advantage plan--so if this "Advantage plan" differs from the other Humana Advantage plans I don't know that they will care---

Last year my husband had to have ER visit w/a scope under anesthesia and subsequent dilation of his esophogus done there in outpatient setting--
but normally not that significant--just walk in clinics for URI type stuff

I have gone to the Medicare.gov site and tried get idea of what conventional choices might cost us if we were to leave the Teacher Retirement System insurance plan--but those choices only use the remainder of the year cost factors--not yearly anticipated ones...

Right now the monthly premiums for myself+spouse are to be 529 a month (for two people)--no guarantee about the year after--our state is GOP run--has not put its fair share into this plan for more than decade so not likely to start now to reduce cost to retired teachers or future retired teachers

My husband has Type II diabetes and hypertension--both since late 20s/early 30s--and it is considered well-controlled but he does take some expensive non-generic RXs...they work for him--
would hate to try new meds and try to achieve control...
so the Part D/RX coverage is very important to peace of mind and health
My RX costs are minimal and generic

When our plan changes in Jan which is after the Medicare normal enrollment period is over
I don't know if trying to change plans after Jan will mean choices are more limited or not

We can't use our FL address as the option for choosing Medigap plans unless we use that as our PRIMARY address and file our income taxes there I believe

Any suggestions/comments appreciated

NOTE: Two threads have been merged. OP asked this question in May and is asking it again. That's why this post is repetitive.

Last edited by in_newengland; 09-20-2017 at 05:55 PM..
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Old 09-20-2017, 11:07 AM
Status: "No longer very optimistic." (set 19 days ago)
 
Location: Coastal Georgia
41,189 posts, read 50,979,381 times
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Ok, for what it is worth, I'll tell you what we have, after hours on the phone and hubby's beloved spread sheets.
We spent a couple of years on an advantage plan and would not suggest one. It was free, and you get what you pay for.
The plans available will vary by state.
Both our plans are AARP, underwritten by UHC.
You want a Plan D, this is for drugs and ours costs $22. @ a month.
We have Select Plan F which costs about $161.@ No deductible, no copays. The select part means we can only go to one hospital unless it's an emergency.
For reasons I won't bother to go into, we will need to change to the non-select F, for a few $$ more or go to a Plan G or N, both of which have a deductible and N has a copay. These are cheaper than the F. However, G is not available in our state.

I was trying to keep it simple, but I fear I haven't. Bottom line, I recommend AARP, F, G, or N, in that order, and definitely PlanD, regardless of whatever medical plan you choose.

You need to do the math, but it sounds like in your husband's situation, you do not want copays or deductibles, better to just pay a bit more monthly premium, which will be less than what you pay now.
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Old 09-20-2017, 01:43 PM
 
29 posts, read 19,539 times
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I completely agree with gentlearts. Medicare is phasing out Plan F in 2020, I would recommend going with Plan G or N.
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Old 09-20-2017, 03:45 PM
Status: "No longer very optimistic." (set 19 days ago)
 
Location: Coastal Georgia
41,189 posts, read 50,979,381 times
Reputation: 71216
Quote:
Originally Posted by MelissaKayLife View Post
I completely agree with gentlearts. Medicare is phasing out Plan F in 2020, I would recommend going with Plan G or N.
If you are already in an F, you are grandfathered, so you can keep it. I just learned that today from the AARP insurance rep. I spoke to. I didn't realize it until today.
Get an F and ride that sucker into the sunset.

Last edited by gentlearts; 09-20-2017 at 04:03 PM..
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Old 09-20-2017, 05:15 PM
 
Location: Wisconsin
23,553 posts, read 50,162,029 times
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F& G are identical with the exception F pays the $183 Part B deductible, G does not.

But AARP charges MORE than the deductible to cover the $183 and will continue to increase the differential as the Part B deductible increases.

EX:
AARP NY Plan F: $193/mo. - Rochester
AARP NY Plan G: $173/mo. - Rochester

Medicare Supplement Insurance Rate: Plan F
Medicare Supplement Insurance Rate: Plan G

Difference - $20/mo.x12=$240/yr. for that region (differential varies). So, anyone with F in Rochester is paying $57/yr more for the policy not to get a bill. My sister, here in WI, is also paying about $57/yr more. She doesn't care - says she's happy never to see a doctor bill. $240/yr. seems to be the common premium for the privilege of having the insurance pay the $183 Part B deductible.

In some areas, the difference can be much higher - ex. NY Proper, the difference is $348/yr. less $183=$165/yr. administrative cost to pay a $183 deductible. I'd think twice about that.

Last edited by Ariadne22; 09-20-2017 at 05:57 PM..
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Old 09-20-2017, 05:46 PM
 
Location: Wisconsin
23,553 posts, read 50,162,029 times
Reputation: 18203
Essentially, OP needs at the very least a PPO Advantage, as was discussed in May, here:

Humana Advantage Plan vs Medicare and Medigap plan

Medication is the biggest issue. If OP chooses a Medigap (recommended if you travel), then a Part D will be required - and that choice revisited annually - as tiers and formularies change.

My sister has a Medigap F + Part D coverage. Drugs are my sister's biggest expense - even with a Part D - she pays about $6k/year. Doctor bills aren't an issue, medication is.

Employer plans are often much more generous - but Advantage plans have their own tiers and formularies - so, imo, in addition to access to medical providers, in OP's case the drug formulary is important.

You might want to try the Advantage plan - and if it doesn't meet your needs - under the "Trial Right," you may be able to drop it and enroll in a Medigap. The examples listed below don't exactly fit your situation.

https://www.medicare.gov/find-a-plan...otections.aspx

Therefore, the above IS a question you should ask at the seminar.

FYI - you are paying a higher premium for Part B b/c of your income. Part D is exempt from that.

Last edited by Ariadne22; 09-20-2017 at 05:58 PM..
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