Posted on 11/22/2018 7:12:14 AM PST by TNoldman
Hi FRiends,
Happy Thanksgiving I hope you are having good weather and a relaxing time.
I have a Question on Medicare Plans. My Wife and I are thinking about Advantage Plans to replace Traditional Medicare. We are 81/83 now and active. We currently have Traditional Medicare with a Gap Policy.
The latest offerings from United Healthcare Advantage Plans seem to have taken care of out-of-network services with their Passport which create instantaneous in-network charges in most States that we visit. Emergency care is Covered in any State. Our current Doctors accept this Advantage Plan.
Our Saving would be about $5000./year (both of us) or a 50% reduction in our Total Healthcare Costs.
What do you think?
Anyone with the Industry experience and/or personal or Family member experience please let us hear from you.
Decision time on or before Dec. 7th!
No additional benefits apply AFTER reaching age 70..Good to know if people can remember. I didn’t remember that. You’re right about beginning withdrawals from an IRA at 70 1/2...You will be notified at the beginning of each year from whatever company has your IRAs, the amount that will be considered the MINIMUM withdrawal that MUST be distributed but more if you choose. Interesting subject and info on this thread...
https://www.ssa.gov/planners/retire/applying1.html
The same is true for a county (Lincoln) in the state of WA where we have friends and I recommended they look into Medicare Advantage - none available there. So they have Original Medicare and bought the drug plan - Part D...
I’m trying to avoid anything related to AARP because of their support for Obamacare.
No one is restricted to a network of doctors or clinics or hospitals if they have PPO Medicare Advantage coverage. They would if they have an HMO but seems like you have to make a change now anyway so it’s a moot point.
Doctors should be but are not always careful about sending patients to labs or outpatient clinics for tests etc. We’ve never been caught in the “non payment” scenario as the MA company requires prior authorization but I guess it could happen. The company we have our MA plans with state on the EOB that such and such a claim was “out of network” so the claim was denied and it is not our responsibility. Big fat zeros for that claim.
A big issue that hasn’t shown up here yet is the “outpatient” vs “inpatient” hospitalization for a Medicare patient. That can be a real can of worms. ALWAYS question if you or a loved one is being admitted as an “inpatient”. Most ER or hospital personnel will understand just why it’s important to ask and to get the answer.
There are cases where a person gets stuck with the entire hospital bill because they were admitted as an “outpatient” - took up bed space in a room for several days, diagnostic tests run up the wazoo and weren’t considered inpatients.
I’ve always asked when my husband has been admitted from the ER to the hospital since I learned about that. Makes for interesting and frustrating reading online...
Marker
You make some very good points
Medicare part A is automatic, part B is “voluntary”, but if you don’t sign up for part B, you will be charged extra for life for every month you delay. My mom paid extra for close to 30 years (she died at 99) because she didn’t know she had to enroll in B. She tried for years to appeal the decision to no avail. The charge for B is taken out of your Social Security payment. If your SS isn’t enough, they send you a bill once a year.
I don’t think Medicare cares whether you’re working or not, unless you are making really big money, in which case they’ll charge you more.
A visit to the Social Security office (assuming you aren’t waited on by a gov’t drone) will get you the answers you need. Trying anything on the phone is an exercise in frustration. Good luck to both of you.
A lot of good insights being offered here! Answered most of the questions I had on this subject.
I think you are talking about being admitted for “observation” - bad if you go straight to long-term care after that.
If a person under 65 is on Medicaid they will not be on Medicare also unless disabled (with some other qualifying circumstances). If a person 65 or over is on Medicare they might get assistance from Medicaid for help paying Medicare premiums.
“”If a person under 65 is on Medicaid they will not be on Medicare also unless disabled “”
You are correct - forgot that little tidbit...
“”I think you are talking about being admitted for “observation” - bad if you go straight to long-term care after that.””
That’s what the doctors will write up - “under observation” when they admit the patient but it’s not right. Not taking up a hospital bed/room for several days, undergoing all kinds of tests and sometimes surgery. Only to a government entity would such a thing be considered “outpatient.” People have had to fight this and it hasn’t been pretty.
Since I first ran across this a few years ago, I’ve long since forgotten the reason for Medicare pushing doctors to write up admissions like this and too tired to look it up.
Here’s an example I hadn’t seen yet - reported just a few days ago.
Another one:
“”I’m trying to avoid anything related to AARP because of their support for Obamacare.””
Amen - same here. I did run across some lower prices on prescriptions with AARP this week but I don’t want to get involved with them and their left wing politics.
Agree UPMC for Life is a great Plan. My wife and I have been on MA plans here in Pittsburgh and previously in TN for over 15 years and they work great for us. We both have heart issues and I have had an ablation, pacemaker & Meds, have had cataract surgery, etc, all very affordable. For next year we are switching to Aetna because of a number of savings, especially prescriptions. Aetna owns CVS (or the other way around)and their prices if you use CVS are way lower. We will pay $40 per mo, NO deductibles and some costs are $225 per inpatient surgery or hospital stay, $150 to $200 for outpatient surgery, $0 PCP visit, $25 for specialists.
They do use networks so if thinking about a plan check their websites which will give a list of all Drs and facilities they usr. We found all of ours in this area on both and never had problems in TN either.
When the bill for the anesthesiologist arrived, I was concerned because that service was supposed to be included in the hospital admission. It turns out that the hospital has an exclusive contract with the particular anesthesiology group. Our surgeon even said he had no choice of anesthesiologists... he always had to use the hospital-provided ones.
Upon further investigation, I found the hospital is a 501c3 charity. As they are a public charity, I asked them to provide a copy of their contract with the anesthesiology group. They refused. I mentioned that a call to the authorities might change their mind. I then got a call from the anesthesiology business office informing us that the bill was being reversed, and they were sorry for any "confusion."
This same hospital paid an $11M fine just a couple of years before because they had fraudulently billed outpatient surgeries. Guess they didn't want any scrutiny on their other shady dealings. While the amount of the bill was relatively small, it was the principal that mattered. I imagine most people pay it, grumbling about the non-network cost. But we took them on, and they backed down quickly.
“”Turns out he was given one additional waiver to sign once he was in the operating arena, and after the IV had been inserted.””
That definitely would have been reason to take them on. No excuse for that but clear to see it was purely intentional. Don’t blame you for fighting. The hospital my husband has been admitted to has notices all over the place that services are contracted to the hospital and are not hospital employees such as lab techs etc. Doctors are those with privileges at the hospital.
I think there can usually be problems when a patient gets handed off to an anesthesiologist. No one asks if they are in network. So far with several hospitalizations my husband had, we didn’t have any problems.
You did the right and only thing you could have done. I know it’s nerve wracking and frustrating but sometimes you just have to put aside other stuff and buckle down to phone calls and letters. I hate the follow up and say there is more stuff piled up on my desk now for follow up than there ever was on my desk when I worked. In other words, my inbox is always full. No one follows through on their promises and that really can get to a person. At my age, I keep a tablet going of all my phone calls and anything I am waiting for responses on.. I do what I say I’m going to do and wish others would do the same.
DMSO, DiMethyl Sulfoxide, quickly dissolves blood clots, and can stop a stroke. FDA does not like it, I think because it has so many healing benefits.
My father-in-law had blood clots in his groin. He had to give himself heparin injections. We gave him DMSO to apply topically and the blood clots were clinically gone in 4 weeks.
A friend of mine had a stroke that partially immobilized his left side. He called me and I said to him, you have DMSO, use it topically and generously. He fully recovered in 24 hours.
I am 83 and on no prescription meds. I plan to keep it that way. I avoid antibiotics, use high doses of Vitamin C if I feel like I am coming down with cold or anything. All mammals except primates, guinea pigs, an obscure bat found only in India make their own Vitamin C. We are primates, we do not make our own C.
I found your post interesting. I don’t have a clue what UPMC for Life is but sure I can look it up. Is it restricted to certain geographical areas?
Our MA policies now are with Aetna and I don’t have any idea about their relationship to CVS. We don’t have one near us anyway. I am looking at our drug costs for 2019 as they are high and I’m considering dropping the PPO MA plans and maybe just going with Original Medicare and buying drug plans.
I have made comparisons with other pharmacies in the area and big surprise - there’s no difference in costs! Have to do some more work on it but I’m running out of steam. Most of our RX do not have generics and I understand Walmart has only generics for their $4.00 price or whatever.
At the rate we went the last half of 2018, we will each be in the “donut hole” by summer of 2019 and I need to avoid that..
I had cataract surgery last year and paid the $225 each time at the surgical center and that was all - just as you stated. I like the idea of “no deductibles” drugs but if we stay with Aetna as is, we will each have a $95 deductible compared to the $75 we each had this year which will have to be satisfied in January when we get our first 2019 refills. It’s the inhalers for COPD that are costly (3 for my husband and 1 for myself) and heart medication for me...Without the heart medication, I wouldn’t have gone in the donut hole this year and he just went in in November.
What a lesson - as if I needed any of it but today is a day of Thanksgiving and I remember those in Northern CA who don’t have what we have....
Let me know what Aetna plan you’re thinking about - I’m leaning toward the same one we had in 2018 - Essential Plan PPO..but doing my shopping before 12/7....
Since we’ve never had any problem with Aetna, I’m hesitant to make a change - wouldn’t even consider it except for the drug costs.
even though Walmart carries lower price generics. Check their brand name price. I needed a supply of a med that was going to cost me out of pocket 5 to 800 at the Walgreen/riteaid/cvs/hannefords and cost me 413 through walmart.
I remember hearing about DMSO several years ago. I think my dad used it for joint pain. Is this the stuff that after you apply it you taste garlic?
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.