A question for our senior citizens

[dick0236]

Rich, you are welcome to PM me. Medicare is confusing. You can opt for a full "freedom of choice" plan, but it will have the highest cost or you can opt for PPOs or HMOs. They will be less costly because they involve contracted reimbursement rates but they also encourage, or require, the use of "network" health care providers. The new medicare ADVANTAGE plans are similar to the PPO or HMO type coverage. In a nutshell, Medicare pays the insurance carrier a "flat amount" each month to cover your care. You do not leave the medicare system but all of your dealings are with your insurance carrier.

Many people do not care for "restricted" coverage offered thru PPO or HMO plans. I opted for this type of coverage many years ago (long befor I went on Medicare). I have never found the "restrictions" to be a problem. If anything, my coverage has been more complete than under the traditional "freedom of choice - fee for service" plans.

Currently, many ADVANTAGE plans have little or no premium that is paid by the insured member. I doubt that these low or no cost plans will continue indefinately and the rising cost of healthcare and government medicare changes will require higher premium cost....but right now, in my opinion, they are really good deals. When they change, I will change.

There are generally several plans in a geographical area that are contracted to offeer ADVANTAGE plans. These are normally big players such as Anthem BC/BS, Humana, etc. I believe that AARP now offers an ADVANTAGE plan thru United Health.

On a side note I looked up the drug Verapamil hcl in my formulary. It appears to be a Tier One drug and would cost $8/mo. Couldn't find the other drug. This doesn't mean all plans would cover the drug in the same way, but it is a good indication that other plans would provide similar coverage.

 

[Ross]

Rich, you are welcome to PM me. Medicare is confusing. You can opt for a full "freedom of choice" plan, but it will have the highest cost or you can opt for PPOs or HMOs. They will be less costly because they involve contracted reimbursement rates but they also encourage, or require, the use of "network" health care providers. The new medicare ADVANTAGE plans are similar to the PPO or HMO type coverage. In a nutshell, Medicare pays the insurance carrier a "flat amount" each month to cover your care. You do not leave the medicare system but all of your dealings are with your insurance carrier.

Many people do not care for "restricted" coverage offered thru PPO or HMO plans. I opted for this type of coverage many years ago (long befor I went on Medicare). I have never found the "restrictions" to be a problem. If anything, my coverage has been more complete than under the traditional "freedom of choice - fee for service" plans.

Currently, many ADVANTAGE plans have little or no premium that is paid by the insured member. I doubt that these low or no cost plans will continue indefinately and the rising cost of healthcare and government medicare changes will require higher premium cost....but right now, in my opinion, they are really good deals. When they change, I will change.

There are generally several plans in a geographical area that are contracted to offeer ADVANTAGE plans. These are normally big players such as Anthem BC/BS, Humana, etc. I believe that AARP now offers an ADVANTAGE plan thru United Health.

On a side note I looked up the drug Verapamil hcl in my formulary. It appears to be a Tier One drug and would cost $8/mo. Couldn't find the other drug. This doesn't mean all plans would cover the drug in the same way, but it is a good indication that other plans would provide similar coverage.

Thanks Dick, this is what I was trying to get across to Rich. There is no way I could afford to stay on traditional Medicare and had to choose an advantage plan. I have had no problems with restrictions outside of needing dentures, which I'm up to my 3rd level appeal now. HMO doesn't want to admit to the new laws that state valve replacement persons can before valve replacement or for life threating conditions, which it would be if my teeth get infected and cost me a valve.

 

[ShezaGirlie]

An old queen here too...

An old queen here too...

Well, I never thought I'd look forward to turning 65 but it's going to be a big payday for me to get rid of this private health insurance - BCBS - which has a deductible of $7,500 plus a $5,000 co-pay. So, all of y'all who are on Medicare - I really appreciate this thread. Just one more premium and I'm on Medicare...hip, hip, hooray..!!

Yep, it's a mountain of info that we need to digest. I'm looking into one of the Medicare Advantage programs here in Texas called Humana Gold Plus and the one plan Humana has which doesn't have a monthly premium at the present time. Dick has given great info about the Advantage plans and I really think they are the way to go. Yes, you'll be on an HMO and need a physician referral - but what's the big deal about that? Nada, for me.. And as Dick mentioned the 'drug tier' puts many drugs at a reasonable cost. So, that needs to be checked out too before one signs on.

I have an appointment next Wednesday with my insurance guru and I will have many questions for him. He's up on HR6331 http://www.govtrack.us/congress/bill.xpd?bill=h110-6331 and that's a good thing. A sad day it was when our leader the President issued a veto on this bill; however, the Senate attempted to override the President's veto of this bill, and the vote passed, by roll call vote. The totals were 70 Ayes, 26 Nays, 4 Present/Not Voting. Now who's out of touch?!?!

For me, one good thing about an Advantage plan is the difference between a Medigap lifetime travel allowance of only $50,000 and the Advantage plan having no lifetime travel allowance cap..

My neighbor has had Secure Horizons for 14 years and had hip surgery completely paid for and her surgeon was the Spurs surgeon. I won't chose Secure Horizons though because they don't have my local hospital in their net. Most doctors are on both the Secure Horizons and Humana Gold Plus plans...and most all the hospitals in San Antonio are too.

If anyone has any questions they'd like me to ask my insurance guru...shoot me a PM or post and I'll be happy to oblige.

 

[Rich]

Janie,
I just can't believe you are going to be a senior citizen.
Where has our life gone?
Rich

 

[marie]

Rich

I really can not offer any advice but wanted to tell you how horrible that must be. My husband and I are on Medicare as primary however he was able to keep his insurance from work. We pay some of that premium. Between Medicare and that insurance we do not come out of pocket for hospital/doctor and we have a co pay for prescriptions. No dental, vision or long term care included in that. I can not imagine that being pulled but I can see that it does happen.

I worked outside the home as well but was never promised any benefits once I retired.

I'm not able to offer any help except to say that you're in my thoughts and prayers.

 

[Rich]

Thanks Marie,
Just to show people what a big deal this is, there are 97,000 of us !!
And that is not counting our spouses!
Rich

 

[catwoman]

Rich:

Thanks for bringing this up. I'm sending a co-worker a link to this thread.
He told me that his dad -- now in his 80s and who worked for GMAC, I think -- will lose his benefits at the end of the year. (BTW, his dad had AVR several years ago.)

James' dad may have found something by now.

On another note: my employer offers very minimal insurance to retirees -- high deductibles and usable only for "catastrophic" situations, I was told. It will be offered only through Dec. 31, 2008. Anyone retiring after that will not get any medical/health insurance.

 

[Rich]

Thanks Marie,
I hope you and your husband can keep your benefits for a long time to come.
Most of this is related to our poor economy.
Rich

 

[Ross]

Economy? What economy? There used to be one, not so anymore.