Medicare Advantage Question

[John & Joann]

I need some assistance from others that have Medicare Advantage. Joann has been going to the Coumadin Clinic for many years. Jan. 1, 2010 we are be mandated to Medicare Advantage.

Do you pay the co payment for your regular visit. I have heard 2 versions. The new insurance company says that we must pay the $15 when we visit the clinic. (each time until we have met the $2000 deductible.)

Your assistance is very much appreciated.

John & Joann
Still clicking since 1971

 

[hensylee]

Mandated? You are made to go this route? I can't answer your question because I don't know but think there are others here in Medicare Advantage plan. I am on regular Medicare.

hope all is well with you both.

 

[dick0236]

I need some assistance from others that have Medicare Advantage. Joann has been going to the Coumadin Clinic for many years. Jan. 1, 2010 we are be mandated to Medicare Advantage.

Not sure I understand your sentence "Jan.1, 2010 we are mandated to Medicare Advantage". I have had a Medicare Advantage for the past three years with Anthem BCBS. I was getting my "finger sticks" at my PCP who did not charge an office visit copay and the test was covered 100%, so I had no cost. My cardio also had a coumadin clinic and although my test was covered 100%, I had to pay a $20 office visit copay. I think it depends on how your coumadin clinic or doctor charges/codes the service. I have gone to self-testing and have not yet seen how the claims will be paid, although I have been told my responsibility will be about $6 to $8 per test. My experience with Advantage plans is that you MUST be careful to use providers in the Plans' network....or make sure you have written approval to go "out-of-network".

 

[ALCapshaw2]

John & Joann -

Are you currently on "Original Medicare" with a Medicare Supplement?

How can you be "mandated" to change to a Medicare Advantage Plan? I always thought you could choose annually during the Open Enrollment Period. What Gives???

'AL Capshaw'

 

[John & Joann]

We currently are on Medicare with a group Medicare Supplement. (Good Coverage), The group (State Teachers Retirement System of Ohio) made the decision on our behalf that the group will be moved into Medicare Advantage. Our monthly premium will drop, equal coverage (we were told) but there is a $15 co pay for every procedure or appointment.

I object to the $15 for the protime test. I am doing my homework prior to the Jan. 1 change.

Hope this helps to explain my question.

 

[ALCapshaw2]

OUCH !

Sounds like "Big Government" telling you what you can and cannot do! I'm sure the reason for the change is that it Saves THEM Money.

Maybe you need to become "community organizers" and protest that move by the Powers that Be in the Teachers Retirement 'Group'.

Another disadvantage of Advantage Plans is that members are usually limited to using Participating Providers within their Network which is usually limited to their state. Is Cleveland Clinic considered to be a Participating Provider for you under the new plan?

Advantage plans also have a fairly sizable 'co-pay' or 'deductable' for EACH Hospitalization. The exact rules probably vary on a state by state basis. It would be a good idea to call the Advantage Plan Provider and ask them to send you the complete Plan Rules and Guidelines to look for other 'liabilities'.

One of the BIG "Advantages" of Original Medicare (and Medicare Supplement Policies) is that you can see ANY Provider ANY Where for ANY Reason with NO REFERAL Necessary.

Good Luck !

'AL Capshaw'

 

[John & Joann]

Cleveland Clinic is approved and a participant. We are "up the creek" and have no other options except to research. The big issue is that Joann MUST have antibiotic infusion prior to dental. $700 per. Medicare covers this activity. Advantage has not responded if they will cover this treatment. That is $1400 a year plus any dental emergencies that may happen. This is a medical issue and not a dental issue.

 

[olefin]

I tried one of those Advantage Plans once. Did not like them telling me what doctor I had to see, having to have a PCP to make referrals and the co-pays.

I probably pay a little more for BlueCross Medi-Pak but it's well worth it to me. I go to the doctor of "my choice" without any referral and never pay a cent.

That's another big reason I don't want the government messing with my health care.

 

[Cozycat]

John and Joann, my husband and I were involved in a situation much like you are going thru about three years ago. We belonged to an organization thru which we got our health insurance. It was an HMO--Kaiser Permanente. Well, it was a truly great plan written many years ago and had such low or no co-payments that we felt very fortunate to have it. But, Kaiser required the organization to have over 1,000 people enrolled and when enrollment fell below that area, they cancelled the program beginning in Jan. of the next year.

By that time both my husband and I were on Medicare so joined the Kaiser Senior Advantage Plan. We currently have somewhere near $96.00/month each deducted from our SS checks. Our co-pay is not too bad...$5.00 office visits, $15.00 lab tests (but since I get my INR tested about twice a month, I can often combine other lab tests in my visit and still only pay $15.00. We have both been very satisfied with Kaiser and like the idea that almost everything can be done at one location.

For my AVR in February, think we paid $1100 out of pocket. To us this was great because we spent about 20 years with no insurance and know what medical costs can be.

But your best bet is to call the Member Services or Customer Service at each plan you might be considering and ask for a copy of their coverage manual. (That way you have it in writing.) Then if you have further questions, such as Joann's specific needs, you can call and ask about the coverage and ask for a written reply.

And I'm with Dayton....don't want nobody messing with my Medicare.

Midge