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Ross,
I guess that's why people really have to do their homework, because it's different in every state. Like I said around here advantage plans are out of sight, and if the government gets it's way they may cease to exist.
As an example we have freinds that live about 150miles north of us. The plan they signed up for with a private insurer costs them about $99/mo, so we had the agent come down to our house. For the exact same plan as our friends have our premium would have been $155/mo for each of us. It didn't make sense but we have seen it over and over.
Our Part D plans have been pretty good though. People also need to be aware that many Part D plans are charging a yearly deductible this year, previously we had none. These can range anywhere from $100/yr to $300/yr.
We are doing OK with the Part D plans we have.
Under the GM plan Coumadin was costing me about $65 for a 90 day supply.
Last year my Part D plan charged me $46 for a 90 day supply.
This year the same exact plan is charging me $16.26 for a 90 day supply. And that's for the brand, not warfarin. I can live with that since I had problems trying to go with the generic.
It really would be nice for everyone if all these things were the same from state to state.
It can be a really confusing nightmare for people to pick and choose.
Rich
 
On the insurance front.... Texas has a high risk pool and I automatically qualified for that policy since I have an "artificial heart valve". The cost was based on:
1. deductible chosen - I chose a $7,500 deductible plan with $5,000 out of pocket
2. zip code I lived in - lived in the cheapest zip code they listed and there are loads of zip codes in TX (mine happened to be a healthy bunch)
3. my age - I had that insurance from age 56 to 65
4. smoker or non-smoker - non-smoker

When I got old enough for Medicare, I got rid of that $500 a month insurance premium that I never collected one thin dime on. Lucky me..!
 
If you go with an Advantage Plan, you may not need a Supplemental policy. If you stay with original Medicare, you'd be crazy NOT to get a Supplemental policy.

Actually, you cannot have an Advantage plan and a Supplement. When you enroll in an Advantage plan, the monthly funds that Medicare allots for you all go to your Advantage plan. I've known a few people to try to do both, but the premium you would pay for the Supplement would be just like throwing money out the window. You would have no benefits with the Supp because you no longer have only original Medicare.

That's why some people don't like Advantage plans. They've been told, or they think, that they lose Medicare when they enroll in an Advantage plans. Not true, because you cannot enroll in without Medicare. You use your Medicare benefits exclusively through the Advantage plan.
 
Ross,
One really good point on the benefits that you posted is the OOPM, out-of-pocket-maximum. Not all Advantage plans have them. I would prefer one that does.

Unfortunately, the plans do vary so much from state to state and even county to county. California is a highly competitive market, and there are lots of plans in most areas. I hope they're still around when I'm Medicare eligible.
Luana
 
Ross,
I guess that's why people really have to do their homework, because it's different in every state. Like I said around here advantage plans are out of sight, and if the government gets it's way they may cease to exist.
As an example we have freinds that live about 150miles north of us. The plan they signed up for with a private insurer costs them about $99/mo, so we had the agent come down to our house. For the exact same plan as our friends have our premium would have been $155/mo for each of us. It didn't make sense but we have seen it over and over.
Our Part D plans have been pretty good though. People also need to be aware that many Part D plans are charging a yearly deductible this year, previously we had none. These can range anywhere from $100/yr to $300/yr.
We are doing OK with the Part D plans we have.
Under the GM plan Coumadin was costing me about $65 for a 90 day supply.
Last year my Part D plan charged me $46 for a 90 day supply.
This year the same exact plan is charging me $16.26 for a 90 day supply. And that's for the brand, not warfarin. I can live with that since I had problems trying to go with the generic.
It really would be nice for everyone if all these things were the same from state to state.
It can be a really confusing nightmare for people to pick and choose.
Rich

Yes people do have to do their homework. It stinks that it's setup the way it is, but it's another hoop to jump through that we have to do.

Actually, you cannot have an Advantage plan and a Supplement. When you enroll in an Advantage plan, the monthly funds that Medicare allots for you all go to your Advantage plan. I've known a few people to try to do both, but the premium you would pay for the Supplement would be just like throwing money out the window. You would have no benefits with the Supp because you no longer have only original Medicare.

That's why some people don't like Advantage plans. They've been told, or they think, that they lose Medicare when they enroll in an Advantage plans. Not true, because you cannot enroll in without Medicare. You use your Medicare benefits exclusively through the Advantage plan.

Glad you pointed that out. I'd totally forgotten it.
 
PPOs work pretty much the same as a non-Advantage PPO.
Luana, You post some great info, thanks.
I failed to mention that my wife's new plan is a PPO. So far it's been just like her previous supplement plan other than a copay for each trip to the doctor.

Under the GM plan Coumadin was costing me about $65 for a 90 day supply.
Last year my Part D plan charged me $46 for a 90 day supply.
This year the same exact plan is charging me $16.26 for a 90 day supply. And that's for the brand, not warfarin. I can live with that since I had problems trying to go with the generic.
Rich, that's a good price for coumadin. I had been getting mine through VA, they were charging $24 for 3 months. Then last year started requiring they do the testing and dosing. I refused that offer and started buying warfarin local for $10 for 3 months. Warfarin works the same for me.
 
Dayton,
That's good you can use warfarin, most seem to have no problem with it.
I'm just one of the 'lucky' few that had problems with it.
I tried it at my cardiologist's request, and my INR dropped like a rock in a matter of days.
It wasn't due to any medication,diet,or activity changes. All we could figure is it just metabolized in my system way too fast. This may have been due to the fillers used and so forth.
Rich
 
Original Medicare

Original Medicare

We decided on what they call "Original Medicare" instead of Medicare Advantage and have not been sorry. Albert's former employeer picks up part of the Medicare secondary for us. This includes drugs and allowences for hospitalization and the like.

We chose this plan, although it does cost more than an advantage plan, because we want to have the opportunity to select our doctors and hospitals. We are totally sold on the Mayo Clinic and definately would not go elsewhere for treatment of our serious ills. The down side is that we had out of pocket expenses at the Mayo last year for Albert in the neighborhood of several thousand, thus leaving us with a good amount to pay.

Unfortunately, both the Mayo Clinic and our beloved internist do not accept Medicare assignment. But, you can still go there. At the Mayo, we have to pay what they charge, which by law is the amount that Medicare would allow plus 15%. They are not allowed to charge more than that. They bill us and give us about a month to pay. In the meantime, Medicare sends a check to us for the amount they allow and our secondary sends us a check for their portion. We must pay the remaining. And, now I am scheduled for a procedure, next week, that will probably result in our having to pay a goodly sum once again.

When we go to our doctor, whom we love (His office is 1/2 mile from our house.) we must pay for the office visit then and there. Medicare and our supplement then reimburse us for their parts of the bill. This doctor is worth the world....All of his office staff are well trained and they just love Al. He's been with this doctor since his valvereplacement in 1990. He takes such good care of me too....Actually, he's the one who sent me to Mayo some years back for ovary removal. We can email him with questions and, if something big were to happen, we have his home number.

To move back to the topic here, I know many people who are just delighted with Medicare Advantage...And, I would be just as delighted if it were not for the special circumstances that I believe we have. So, for those who believe that they have circumstances that need special types of treatments, you might want to consider other Medicare options.

Kindest regards,
Blanche
 
Supplement vs Advantage

Supplement vs Advantage

Blanche, you've raised several excellent points about having original Medicare with a Supplement.

For some, the big advantage of the Medicare Advantage plans is the lower monthly premium; however, the Supp is the Rolls Royce, and I would say, the way to go if you can do it. It will give you the ultimate in freedom and flexibility. If you want to be able to go to different doctors or hospitals for second opinions or specialized services, the Supp is the choice. For peripatetic seniors, or even those who spend a few months here and a few months there, an Advantage plan is not a good idea. Advantage plans are not a one-size-fits-all and my enthusiasm for them does not exclude enthusiasm for Supplement plans either.

Some people do get Medicare Supplement insurance (or an allowance for it) as part of their retirement benefits. This, to me, was always where I would end a conversation if I was dealing with someone interested in an Advantage plan. I'd say if you're getting benefits to go along with Medicare from your former employer, don't change anything! It's really important for those who are getting Medicare benefits as part of their retirement to not change a thing. I've heard horror stories of people losing pensions and/or other benefits because they enrolled in a Medicare Advantage plan that they should not have.
Luana
 
With Advantage plans, depending upon the plan you choose, you either have to see the plan physicians and use the plan hospitals or get preapproved to go out of plan by referral, or some plans allow you to see any doctor and use any hospital. It all depends on what's offered in your area. I'd give you an example, but you can't post the links from your searches on the Medicare site. It just doesn't work.

Not only do Advantage Plans require that you use the Network Physicians / Hospitals / Providers, but your Primary Card Physician acts as a "Gate-Keeper" in that he is the one who decides IF / When you may consult with a Specialist from what I understand.

With Original Medicare (and a Medicare Supplement) you can see ANY Doctor ANY Where for ANY Reason, including Specialists. IF you want to be able to select a Surgeon who specializes in what you need, this seems like the best option from my point of view.
 
Not only do Advantage Plans require that you use the Network Physicians / Hospitals / Providers, but your Primary Card Physician acts as a "Gate-Keeper" in that he is the one who decides IF / When you may consult with a Specialist from what I understand.

With Original Medicare (and a Medicare Supplement) you can see ANY Doctor ANY Where for ANY Reason, including Specialists. IF you want to be able to select a Surgeon who specializes in what you need, this seems like the best option from my point of view.

Not true of all of them, but most, yes. Thing is Al, you have to be semi wealthy to afford to play on the Traditional Medicare board. Most people cannot afford it.
 
Al,
Not all Advantage plans are HMOs. There are PPO plans and Private-fee-for-Service, PFFS, plans where you do not need a PCP referral for a specialist; you can self-refer with those plans; only HMOs require a PCP referral. PPO plans have the option of using services out-of-network, and PFFS plans have no networks.

Supplement plans do offer the most and best when it comes to freedom and flexibility and are an excellent choice; however, not everyone has room in the budget for a Supplement. My thinking is if you do, certainly choose that option, if you can't, select an Advantage plan that works best for you.
Luana
 
the Supp is the Rolls Royce, and I would say, the way to go if you can do it. It will give you the ultimate in freedom and flexibility.
or even those who spend a few months here and a few months there, an Advantage plan is not a good idea.
That's was what was upsetting my wife until she found out it was a PPO. She's still not real happy with the copay. Her plan cost is about the same as my supplement but she has prescription coverage.


Not only do Advantage Plans require that you use the Network Physicians / Hospitals / Providers, but your Primary Card Physician acts as a "Gate-Keeper" in that he is the one who decides IF / When you may consult with a Specialist from what I understand.
My wife has a Advantage PPO, it's almost the same as my supplement plan, other than she has a $15 copay for each time she goes to a doctor.
 
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