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Location: Unlike most on CD, I'm not afraid to give my location: Milwaukee, WI.
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Terry, the UHC Medicare Advantage Plan (affiliated with AARP) that I am considering does not require referrals to specialists. Plan is called AARP Medicare Advantage Value (HMO-POS), with 0 premium. Another possibility is the AARP Medicare Advantage (HMO-POS) for $27 premium.
Gregg, the reasons I looked at Medicare Advantage plans was 1. Yeah, cheap. No or low monthly premium, 2. Drug coverage included, and 3. Just to keep things simple and have everything covered with one insurer/one card and have the least hassles. Right now I have BCBS retiree insurance from my last employer, and that is hard enough for us to keep straight, frequent billing questions or errors by either BCBS or provider we have to sort out over the phone. My thinking is that having separate Original Medicare, plus a supplemental/gap plan, plus a drug plan could make things more troublesome. At this stage I don't need more problems/stressors than I've already had in life.
I am definitely going to talk with an agent and hopefully be advised what would be best for me. I also came across this which gives me second thoughts about an Advantage plan:
Location: Unlike most on CD, I'm not afraid to give my location: Milwaukee, WI.
1,770 posts, read 4,122,761 times
Reputation: 4045
Thanks janellen for the tip. I am really rethinking the Advantage thing now, and may end up going with the original Medicare + supplemental + Part D coverage. As I told Gregg, I have reservations about the hassle of keeping 3 different plans straight, but, for example if I got the supplemental AND Part D from the same outfit (i.e. UHC), that might simplify matters. As I also told Gregg, I am going to get advice from an agent nearby who is, among other things, a UHC rep/liaison.
I would rethink this decision. My husband has retiree BCBS and with Medicare A and B, we never have to deal with bills. We don’t have a clue who pays what. But he’s covered. Simplify our life.
Thanks janellen for the tip. I am really rethinking the Advantage thing now, and may end up going with the original Medicare + supplemental + Part D coverage. As I told Gregg, I have reservations about the hassle of keeping 3 different plans straight, but, for example if I got the supplemental AND Part D from the same outfit (i.e. UHC), that might simplify matters. As I also told Gregg, I am going to get advice from an agent nearby who is, among other things, a UHC rep/liaison.
Just remember that no matter which company you start out with for Part D, you should check each year to see if it would be beneficial to change to another plan. The insurance companies are constantly changing the premium amounts, deductibles and the tiers for prescriptions for the next year. If you just "set it and forget it" when it comes to part D, you might find an unpleasant surprise sometime down the road.
Thanks janellen for the tip. I am really rethinking the Advantage thing now, and may end up going with the original Medicare + supplemental + Part D coverage. As I told Gregg, I have reservations about the hassle of keeping 3 different plans straight, but, for example if I got the supplemental AND Part D from the same outfit (i.e. UHC), that might simplify matters. As I also told Gregg, I am going to get advice from an agent nearby who is, among other things, a UHC rep/liaison.
There's actually no hassle with original medicare and gap for me. I just pay my gap premiums and part D yearly and that's all I have to do. No other action is needed. If you think you'll have to pay on a monthly basis, then it might be a hassle. My precriptions are all Tier 1 so I'm signing up for the Walmart-Humana basic drug plan this year when open enrollment comes up next week. $13.50/month = $162/year. I check formularies and plans every year before open enrollment and change if I need to.
If you have Original Medicare, you do not need a referral to see a specialist. However, if you are enrolled in a Medicare Advantage plan instead of Original Medicare, then you may need a referral, depending on your plan’s rules.
Also, I've heard, but cannot confirm, that some doctors are turning down patients with Advantage plans as opposed to Gap plans. Might want to check with your doctors and see which ones they prefer. I have Anthem BCBS gap insurance and am happy with them.
Location: Unlike most on CD, I'm not afraid to give my location: Milwaukee, WI.
1,770 posts, read 4,122,761 times
Reputation: 4045
Janellen... thanks for more good tips and info. The consensus here is that these Advantage plans may not be the way to go. So now I am leaning way more toward the gap + plan D method. Wow. I'm glad I posted this question, and learned so much.
Also, I've heard, but cannot confirm, that some doctors are turning down patients with Advantage plans as opposed to Gap plans. Might want to check with your doctors and see which ones they prefer. I have Anthem BCBS gap insurance and am happy with them.
Our family doctor does not accept Advantage Plans as, according to her, they tend to pay very slow, require multiple filings and generally a PIA.
Again, the biggest issue with an Advantage Plan is the good possibility that "someone" will not be in the network which will end up giving you a nasty surprise.
The great attraction of an Advantage plan to a senior is the very low or even zero cost. Seems like a no-brainer, right?
Yet, in spite of that, many end up going with traditional Medicare plus a supplemental plan ("Medigap").
Advantage plans can limit or deny treatment or payment of claims. Just last year the New York Times reported, "Medicare Advantage Plans Found to Improperly Deny Many Claims." NYT has a paywall, so I can't post a link.
"As Seniors Get Sicker, They're More Likely to Drop Medicare Advantage Plans"
Mr. Kool, the foregoing thread is just three threads below yours on the first page of this forum. If you haven't read it yet, do so.
If you can afford a Medigap, that's what you should have. I know that FEHB BCBS retiree coverage is even better than AARP UHC plus Part D. I also know you are not FEHB.
You need to further review your retiree coverage. Talk to retirees covered under this plan. Are they still experiencing issues?
Employer retiree coverage, as a general rule, is usually better overall than an outside Medigap + Part D, as it will often pick up payment for services not paid for by Medicare. Don't walk away from that coverage just yet, without more study.
Otherwise, an AARP Medigap + Part D is a hassle free way to get Medicare benefits. Also explore issue-age policies. Both AARP UHC (community-rated) and issue-age plans limit premium increases. Do not under any circumstances buy an attained-age policy unless you decide on a high-deductible Medigap which, if you are healthy, can be a cost-effective way to get all the benefits of a full Medigap at a much lower premium.
If you are not familiar with Medigap pricing, more info, here:
Last edited by Ariadne22; 10-13-2019 at 10:14 PM..
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