VANITY - Medicare Advantage Advice

[zigmeisterxiv]

If there is a different place to post this, please direct me.

My Medicare begins Feb. 2, and I'm figuring to sign up for an advantage plan, but my lazy self hasn't done enough research on this.

Those of you in the know, any advice is appreciated.

65, male, caucasian, 5'7", 180-195 lbs., reside in Florida, no wife or ex-wife, no children, travel to Hawaii, drive to NY and California, spry, no medications, no chronic ailments other than mild sciatica, good mobility, no arthritis, drink daily (after 6 PM), SS + pension + other ~ 3000/month, cash reserves about $150k, no current physician as just moved to Fla, what else?? Max value for minimum cost!

Appointment with Humana peeps next Monday. Do they stink, superior, or same as the others? Most sensible plan for me??

My humble thanks for any insights you can provide ...

Mahalo Hui Loa

zig

[campaignPete R-CT]

I ditto comments in post 5

Take low premium supplement

If ur not spending big on Rx, Humana has Part D for about $10 per month

[Salvation]

http://www.freerepublic.com/focus/news/3625793/posts?page=19#19

[Salvation]

http://www.freerepublic.com/focus/news/3625793/posts?page=19#19

[Ken H]

I’d like to second what another poster said about Advantage plans owning you. They may be good now, but you never know how they’ll rewrite the rules 5 or 10 years down the road. I don’t like the idea of a gatekeeper.

Once you’re in an Advantage plan, you can’t switch to Plan G or F without medical underwriting.

[Mears]

“but they can seize any assets you might leave behind when you die in order to recoup what they paid out for your care.”

---

That can be avoided by trusts.

.

[TomGuy]

Once you qualify for Medicare, you MUST also have or get acceptable drug coverage. You earn a penalty for each year you do not have drug coverage. If you later get drug coverage, the penalty is cumulative and you play it even after you get drug coverage. It is only a few $$$, but they are cumulative.

Once you do get drug coverage, you do not have new penalties, but you are still assessed the penalties for each year you did not have drug coverage.

[It is kind of confusing.]

[exit82]

Bump for later reading.

[MAKOTHEDOG]

Humana is is fine if it meets your needs, mainly if your doctors and such are in a network. Your doctor might not be in a network an therefore an Advantage plan might not appeal to some people.

Supplement/ Medigap plans:

Can be used in any state or US territory
See any doctor that accepts medicare
Can have no out of pocket costs (Plan F but G is a close second because cost saving s paying the annual Part B Deductible) for Medicare approved services and if the doctor accepts Medicare.
No Drug Plan... Need a stand alone plan

Medicare Advantage:

Work in a network (HMO or PPO) HMO- need to use network doctors and hospitals. PPO costs are less in a network but can pay more to uses services out of the network

Copays and Co Insurances (% of the cost)

Do typically come with drug plans.

Everybody has different views about which direction one should go. You can see in my profile who I am with if you need questions asked just email me here. I will be happy to talk to you about all of your options.

[Just_Sue]

I’m a former Medicare Insurance Agent (now retired). I was healthy when I chose to go on Medicare, but knowing that your health can deteriorate as you age, I chose to buy a supplement rather than go on an Advantage Plan. Turned out to be an excellent choice as I did in fact develop some issues that my supplement covers in full.

My husband was also in good health at retirement, and he chose an Advantage plan. $0 cost. BUT, he really got sick and now he can’t qualify for a supplement which would save us a lot of co-pays and other costs.

You just need to make a decision that makes sense to you. Supplements are government controlled, so shop price. They all have to provide the same benefits.

Check with your current health provider and see what plans they are associated with. That way if you choose an Advantage Plan, they can remain your doctor. Advantage plans are HMO’s whereas Supplements allow you to go anywhere.

[campaignPete R-CT]

Avoid penalties. Humana part D is now 20.40 $ per month

[snooter55]

Indeed, for LATER ! ** MEDICARE MAZE **

[Intolerant in NJ]

Just our experience - wife and I have been on Medicare for about fifteen years each - our former employer provides coverage which in turn selects several Medicare plans of various descriptions from which we can select every year, but they assign us to one primary plan which we can abandon to go to another if we want - up until last year this worked fine - the plan to which we were assigned (a Horizon product) was "original Medicare" and covered virtually all our needs - we're both relatively healthy - for nominal costs - in January 2016 we were notified that our plan had been changed to an "Advantage" plan - not a lot of difference in costs to us, but right away we had to start getting preapproval for special tests and some consultations from the company - something we had never faced before - fortunately most physicians ordering special consults or tests will have their office staff get the prior authorization, but it is an added irritant - apparently to many of the doctors themselves - toward the end of last year the orthopedist my wife sees regularly started lectures at almost every appointment about how bad Advantage plans are, and urging us both to get back on an "original" Medicare plan - he says advantage plans receive an average payment for each patient from Medicare which they then use to pay patients' bills as they come in - this is fine as long as the average cost per year is less than the yearly average the plan gets (about $8000), but once it goes over that the plans start to monitor very carefully and resist paying in every way they can additional bills raising their costs - essentially the plan and not Medicare is now paying the bills and apparently hassle the docs and sometimes the patients themselves about needed treatments and tests to hold their costs down - fortunately neither one of us has had bills amounting to the critical level yet, so we have no idea how uncomfortable this might become for patients or how disruptive it might become for the doctor-patient relationship - wife asked several other doctors she sees for their opinion - both agreed it was a problem, although one added that we had good coverage so why fight it - for us to go back to an available original Medicare plan would cost us some money up front, but it might be worth it in case either gets really sick and requires extensive care.....

In short - it seems doctors don't like Advantage plans - they probably limit some payments to the docs and probably cause them major headaches in pursuing the care they think their patients need - apparently some doctors are not accepting patients with such plans, so you might be limited in who you can get to see - the plans seem okay from the patient's standpoint - as long as they don't get really sick, in which case they might have major problems in getting all the care they need when they need it because the plan is out to save itself money - the tradeoff seems to be a bit higher upfront costs in return for a better chance of getting extensive and costly care later if needed - good luck.....

[Aliska]

You should have an in-hospital option (you never know), prescriptions, can't think of the other one. For a little more in premiums, you can eliminate most co-pays. That's one of the worst problems with it. Going to a family-type doctor is 0 copay this year, but every specialist, IOW a referral to Gastro, Psych, Physical Therapy is $30 EACH visit which can add up fast. So I go without most of that.

I think a FReeper told me that Plan F costs a higher premium but eliminates co-pays for specialists.

Here's one thing I ran into. I had a little tiny spot removed from near my wrist with that Nitrogen stuff. They billed Medicare $600 for surgery, several years ago.

More recently I get bouts of painful acid indigestion. The med that works the best is Ranitidine and ignorant about what comes next here. My doc prescribed it, won't name the pharm, well-known, and it's $60/mo. So I'm paying it because I take only when needed even though I saw on the bottle to take 2 times a day. So I call my doc and ask (nicely) if they can prescribe the generic. That is the generic. And they give me something else. I don't like it; it almost seems to cause it to be worse so quit taking it. Get on the web and look up Ranitidine. Saw post about how the capsule was store-name proprietary sort of thing. I see amazon has the same drug, same dosage in tablet form for around $10. So I call the pharm. She goes to look in the OTC meds aisles. Yes they have the one I need, but I forgot to ask how much. Haven't been able to get my daughter to go get it for me yet but she will when she can fit it in her schedule.

In the meantime, I'm using a lot of Rolaids.

Once you get on a plan, make sure you're covered for what you want/need to do next. I went by ambulance on July 4 to where they knew I was covered. I kept getting worse, and by Sep 9, I didn't know what to do so called my ins and asked if a hospital in the next town, same state is covered. It is but not some of the docs they work with and refer to. I thought they might be better. They found a UTC, prescribed for that, and found thru blood test my sodium was too low. So I had a saline drop by IV. Have to keep my salt intake at a certain level even though I'm on blood pressure meds.

And that wasn't anything terribly serious but could have gotten to that point. But my main point here is you have to take charge of your own care, ask the right questions, look things up on the web, etc.

[Aliska]

I forgot to tell you they take about $170 or so out of my annual social security spread over 12 months, and I pay I think $32 this year per month, last year it was $36. That really isn't too bad considering some nightmares we've all read about.

[MAKOTHEDOG]

You explain it well. I wish I could be so forthcoming with individuals but it would be steering. Your husband is a perfect example of someone who can be healthy with an MAPD but down the road might not qualify for a supplement/medigap plan. It happens all the time. It happened to me today.

[Aliska]

Thanks much, Salvation I'm learning, too.

[GOPJ]

There’s a penalty for NOT having drug coverage if you have Medicare. If you don’t want to pay the penalty FOREVER for a drug plan - buy one of the cheap plans. They just want you to have something... Walmart had one a few years back for $17 a month - didn’t cover a lot but it stopped Medicare from being able to force the penalty amount when you do buy a plan.

Check out page 90 in your Medicare Handbook for 2017... (the handbook is called “Medicare and You” and it’s free.) To request Medicare free publications call 1-800 -633-4227

[Aliska]

That can be avoided by trusts.

I'll wager a lot of Medicaid recipients don't know that. I need a trust for a different reason, but they are complicated, and need to be drawn up by an attorney who specializes in it in addition to a will and medical power of attorney or whatever else.

[Ken H]

Great post. Plan G is also a great option.

[zeestephen]

The fact that you travel a lot is usually a big negative for an “Advantage” plan.

Your provider may not work in the states or cities that you enjoy traveling to.

As long as you are in good health, it won’t matter that much.

But if you get sick or injured outside of your provider’s coverage area, expect some big time expenses to show up on your Medicare statement.