Big Decision to Make re: Medicare

[kathyspear]

I am currently insured through my husband's employer. Because it is a small company (30 - 40 employees?) my coverage is pricey. Also, like most people with private insurance, my deductible has quadrupled in the last few years. I have been reluctant to switch to Medicare but am currently investigating my options.

It looks as if I can save $200-300 per month on my premiums if I sign up for regular Medicare, a Plan G supplement, and a drug plan. In addition, if I am understanding what I read about Medi-gap plans, I will save several thousand dollars in annual out-of-pocket costs if I dump hubby's coverage.

Assuming that is correct (and please correct me if it is not!), my primary concern is: Will I have trouble finding doctors who accept my new coverage? Right now I can go to any doctor I want. If he/she is out of network I pay a larger percentage but I can still see that doctor.

I gather I will need to find another primary care dr if I make the switch because I have been seeing someone with TVHS. I have no attachment to that person, though, and have no problem with going elsewhere. BUT I'm terrified that something BAD will happen, everyone will say, "Oh, you MUST see Dr. So-and-So, he is the expert on that problem!" But Dr. So-and-So won't take Medicare patients.

Advice? Comments?

Thanks in advance.

kathy

[villagetinker]

We have AARP United Health care Supplement plans, no problems finding doctors as long as you do NOT want a PCP in the Villages Health Care system, they only accept 3 or 4 ADVANTAGE plans. You MAY have trouble finding other doctors that accept ADVANTAGE plans. Call Florida SHINE (Senior Health Information Network), Google FLORIDA SHINE for contact info, they offer LOTS of unbiased info. They have meetings in The Villages, but not sure if these are currently being held, they also have an 800 number.

[kathyspear]

We have AARP United Health care Supplement plans, no problems finding doctors as long as you do NOT want a PCP in the Villages Health Care system, they only accept 3 or 4 ADVANTAGE plans. You MAY have trouble finding other doctors that accept ADVANTAGE plans. Call Florida SHINE (Senior Health Information Network), Google FLORIDA SHINE for contact info, they offer LOTS of unbiased info. They have meetings in The Villages, but not sure if these are currently being held, they also have an 800 number.

Definitely not looking at Advantage plans. Want a larger pool of doctors to choose from (plus we travel quite a bit). Thanks. Will contact SHINE.

k.

[Carla B]

Your hesitation is that you're afraid a doctor won't accept Medicare + supplemental. Have had Original Medicare + AARP for many years and have never encountered a practice that does not accept it, especially in Florida. Usually, when leaving the appointment, they say "You're good to go." No paperwork, no co-pay, you check in and walk out. Different than an Advantage plan.

There may be exceptions: I have the impression that Mayo Clinic may not accept Medicare plus supplemental as full payment, but I may be wrong about that. Maybe someone will clarify.

[kathyspear]

Your hesitation is that you're afraid a doctor won't accept Medicare + supplemental. Have had Original Medicare + AARP for many years and have never encountered a practice that does not accept it, especially in Florida. Usually, when leaving the appointment, they say "You're good to go." No paperwork, no co-pay, you check in and walk out. Different than an Advantage plan.

There may be exceptions: I have the impression that Mayo Clinic may not accept Medicare plus supplemental as full payment, but I may be wrong about that. Maybe someone will clarify.

Thanks, Carla. That makes me feel a lot better!

k.

[retiredguy123]

Very few doctors, who treat people over 65, could stay in business if they didn't accept Medicare. I don't think you will have a problem.

[LizzieBorden]

I have had Medicare for my primary since I turned 65 and had AARP as my supplement. I think it was Plan F when I sighed up back then. I have had some minor surgeries..been to the Urgent care about 5 time for colds, etc. My first trip ever to an ER, do annual maintenance with my doctors, etc.for the past 5 years...and never received any bill for anything nor have I paid any co-pays. I walk in, and on the way out, they say “you are good to go” and off I go. I consider myself to have excellent health, only one medication for high cholesterol, but one never knows when that will change. I want to be prepared. I also travel all over the US with this, and never had an issue. What I didnt like about The VIllages, is that I couldnt go to the dermatologist that I had been going to for 6 years, I would have had to change. IT was the best decision for me. I dont have to have a referral, I can go to any doctor that takes Medicare and there are plenty. My friend has The villages health care, she has to choose and in-network doctor, and also has co-pays for every dr, and she also had to go to physical therapy and she has co-pays for that as well. AARP was the best choice for me and I have no regrets making that selection.

[crash]

Definitely not looking at Advantage plans. Want a larger pool of doctors to choose from (plus we travel quite a bit). Thanks. Will contact SHINE.

k.

Look at United Health care advantage plan they have nation wide coverage.

[msilagy]

With medicare - a supplement like plan G - and a drug plan D - you can go anywhere to any Dr in any state. If say for example you want to go to Mayo clinic in Jacksonville, in Minnesota too, you can go. No restrictions (except for a plan the villages has but thats never interfered with where I have gone). This is the absolute best way to go. The only out of pocket will be the medicare deductible every year that plan G doesn't pay. $198 for 2020 for example. I travel between Illinois and Florida with no issues. Do not go with an advantage plan no matter what the premium is as you will have out of pocket expenses and restrictions on where and what Dr you see and possible referrals needed. If saving money or a person is convinced of these plans, many people take the advantage plans and don't care about restrictions. I want to myself be able to go wherever I chose. Good luck to you.

[Bridget Staunton]

Sir: will you share the AARP advantage your on. I have AARP Advantage also but I am really worried if I go to hospital that may not be in network I will get stuck with a big bill. I also heard Moffett & UF Gainsville do not accept Advantage Plans?. Your wonderful, thanks for the advice

[Dontee]

Kathy,
I turned 65 in July and started Medicare. The government charges 144.00 a month. I took BC/BS plan G so I could see any doctor I wanted with a cost of 177.99 a month. I also had to find a company selling prescription plans and I selected SilverScript for 25.20 a month. Every doctor takes Medicare and plan G and I’m saving 200.00 a month from my private health care which had a 5000.00 deductible.

[Larchap49]

I have traditiinal Medicare and a plan F supplement with Humana and plan D prescription with Wellcare. I've had no problem finding Doctors and have had no out of pocket expenses even being treated for Cancer.

[JoannMH]

I worked for an Advantage plan for many years until I retired last year. I decided while working, that I would never have an advantage plan when I was eligible for medicare. Most of my colleagues agreed with me. The members that I worked with were frequently complaining that they were being nickel and dimed to death. They were usually confused as to what was covered and what was not; what their copay for each visit or procedure would be; and what doctors they could go to. I now have an AARP medicare supplement plan and although the monthly premiums are higher than they may be for and advantage plan.....I am very happy with my choice. Not everyone qualifies for the AARP plan however. You do have an initial enrollment period where you can automatically qualify, but after that if you have some health issues, you may not be accepted. So I felt that it was better to join during my initial enrollment period rather than wait...in case I developed some non -qualifying health issue. Work with an insurance agent to determine your eligibility.

[Dr Winston O Boogie jr]

I have Medicare and Freedom Health as a supplemental. Freedom has a zero dollar premium. I love my doctors. Primary care visit have no co pay and specialist at $20.

All of the medications that I take have no co pay.

I get $75 a month in over the counter products.

There is a maximum $3,000 per year out of pocket expense.

I am very happy with it.

[Tom52]

DW and I came to TV with Medicare and BCBS Medigap plans from an out of state carrier. Hers is a G plan and mine is an F plan. We both had some difficulty finding PCPs because most doctors in TV are tied into certain health insurance plans. This was very surprising to find out as we always thought Medigap plans were considered better.

Once local PCPs were found all has worked OK for us. I had several emergency room visits to TV hospital and one five day stay in the hospital and my cost has been zero out of pocket. It appears most if not all specialists and hospitals accept Medigap insurance. I believe but am not sure that the Medigap coverage is much more flexible than advantage plans if coverage is needed outside the local area. With Medigap you are not limited to a certain network of doctors.

[gomsiepop]

I will be 75 in February and have NEVER, EVER had a problem going to ANY doctor for the past 9+ years. I had The Villages health insurance for a couple of years until their policy of accepting Medicare insurance changed. I chose not to have any restrictions on which doctors I could see.

[Ytepsick]

You're going to be fine. Your research and thoughts are accurate. Find an independent agent, one who is reputable and been doing this for a while. They can walk you through the whole process quite easily. That person would have to evaluate your current drug list in addition to the supplement. Good luck!

[retiredguy123]

Kathy,
I turned 65 in July and started Medicare. The government charges 144.00 a month. I took BC/BS plan G so I could see any doctor I wanted with a cost of 177.99 a month. I also had to find a company selling prescription plans and I selected SilverScript for 25.20 a month. Every doctor takes Medicare and plan G and I’m saving 200.00 a month from my private health care which had a 5000.00 deductible.
To clarify, the Government charge for Medicare Part B ranges from $144 per month to $491 per month, depending on income.

[debron911]

Kathy,
My mother was on a traditional Medicare plan with her employer and cost her $250 monthly. Her medications out of pocket at least $85 a month. I switched her four years ago to a Medicare Advantage plan with United Health Care - The Villages Complete 2 with a monthly premium of $83. She has had four years of many surgeries, ER visits, hospitalizations, etc and I can tell you the plan has been wonderful. I chose that plan because the MAX out of pocket was $1900 with no annual co-pay. There have been some changes and for 2021 The Villages UHC will only be offering one plan. I will tell you no referrals are needed to see a specialist or pre-authorizations to see a specialist. For 2021 the UHC-Villages plan has a max out of pocket of $2900. Primary doctor visits are zero. Specialists are $40 co-pay. It is a HMO but our experience with the Villages UHC has been awesome. There is a co-pay for ambulance and for 2021 hospital admittance co-pay of $250 for the first 6 days. There is a Medicare office in Sumter Landing. They can answer your questions but we have been very impressed with the quality of the plan and a majority of doctors here take UHC. The irony is that my employer plan Medicare Advantage plan with Michigan BCBS is not accepted at The Villages Health. But my plan is a bit better and I never pay a premium. My mother was reluctant to let her employer paid traditional Medicare go but it was a blessing because of all her medical needs after we signed up for UHC. Good luck, Debbie

[tombpot]

Medicare and Plan G supplement with a prescription plan is the way to go. I moved here no problems finding Doctors taking Medicare. Are you in the sign up period, or the open enrollment? Better check your husbands company policy, I know people that were dropped from company if the spouse passes away.

[Fisherman]

Definitely agree.... stay far away from any Advantage Plan. And not sure how old you are, but your supplemental premium is slightly higher when you do not sign up at 65. Some people think they will take an advantage plan at 65 because they are in very good health and want to save money. Then later they decide to switch to a supplemental and at that point they pay a higher premium due to age and any existing major health issues. Currently, can not be denied, but you pay more. I was in excellent health until a CT scan after a fall hiking they found a benign cyst in my abdomen which the hospital bill alone was over $73K, then a skin cancer that requires a plastic surgeon with repair under general anesthesia. I have Medicare, cost depends on your Adjustable Gross Income on your tax return from two years prior, plus Florida Blue Supplemental “F” Plan (Blue Cross Blue Shield) @ $202.30 a month , and I use WellCare Drug Plan for $13.20 a month. Tier 1 and Tier 2 drugs by mail order are free. Be sure to select the right drug plan, that is the hard part, but most of them you can enter each drug you may take and they will tell you what tier it falls under and the price. Never had surgery or been hospitalized except giving birth and now two in one year! I have been to the Mayo Clinic and paid zero. I have never found a Dr that did not accept my Medicare or supplemental. The Villages Health System use to accept Medicare & supplementals, then a couple of years ago, letters went out to all their patients saying they would now only accept Advantage plans. People were outraged and many left because they refused to give up their supplemental plans. The only down part of a supplemental is you are on your own for dental and most vision issues. Hope this helps.

[Doloreslv]

Regular Medicare plus a supplement allows you to seek service any where, by your choice

[Doloreslv]

Regular Medicare plus a supplement allows you to seek service any where, by your choice

[Kgcetm]

I too have Medicare and AARP Plan F. I have NEVER paid a dime to any doctor for any service and when I am asked as a new patient for insurance information I'm told "no problem". I was in TVHP from the get go and dropped out after a year. Why anyone would want a PCP in that corrupt medical morass I do not know. I think there are more and better doctors out of the system than in the system.

[Gerrys]

We a on Medicare and an AARP supplemental. We can go to any doctor who accepts Medicare. We don't need a referral to see any Medicare doctor. The supplemental picks up the Medicare deductible. Suggest you call AARP to find the supplemental plan that suits your needs.

[toeser]

I am currently insured through my husband's employer. Because it is a small company (30 - 40 employees?) my coverage is pricey. Also, like most people with private insurance, my deductible has quadrupled in the last few years. I have been reluctant to switch to Medicare but am currently investigating my options.

It looks as if I can save $200-300 per month on my premiums if I sign up for regular Medicare, a Plan G supplement, and a drug plan. In addition, if I am understanding what I read about Medi-gap plans, I will save several thousand dollars in annual out-of-pocket costs if I dump hubby's coverage.

Assuming that is correct (and please correct me if it is not!), my primary concern is: Will I have trouble finding doctors who accept my new coverage? Right now I can go to any doctor I want. If he/she is out of network I pay a larger percentage but I can still see that doctor.

I gather I will need to find another primary care dr if I make the switch because I have been seeing someone with TVHS. I have no attachment to that person, though, and have no problem with going elsewhere. BUT I'm terrified that something BAD will happen, everyone will say, "Oh, you MUST see Dr. So-and-So, he is the expert on that problem!" But Dr. So-and-So won't take Medicare patients.

Advice? Comments?

Thanks in advance.

kathy

I suspect you will have plenty of choices, but the doctor I wanted for primary care would not accept new patients on Medicare, even though I had a referral from one of his patients who is a doctor also.

[Villages Kahuna]

You don’t have to change doctors. The Villages Health accepts Medicare Advantage plans offered by both United Healthcare and Florida Blue. Both programs include drug coverage and have zero premium. Both have $2,900 per year maximum out-of-pocket expenses. Medicare Advantage plans also offer a wide variety of additional benefits at no cost such as drug, dental, eye care and hearing aids. Both plans include a free membership to the MVP health clubs. That benefit alone is worth more than $50 a month each for my wife and myself.

I was paying a multiple of the Advantage plan $2,900 max out-of-pocket with premiums for both my wife and myself for Medicare parts A, B and D, and a Plan F supplement. I can see any specialist of my choice. The FL Blue policy has Shands, Moffitt, and several other highly-rated hospitals “in network”. Only the Mayo Clinic is out of network. I don’t think Moffitt or Shands are in network with UHC, at least they weren’t last year and this year.

To learn more, each Villages Health facility has an office that is staffed with both UHC and Florida Blue agents who will explain their programs to you and arrange your enrollment in the program you choose.

Anyone with employer-provided retiree health insurance has probably faced the same issues that you described. When my coverage for my wife and myself was going to cost almost $800 a month for Medicare A and B, an AARP Plan F supplement plus the cost of a Part D drug plans, the need to seek an alternative became obvious. Now I realize how much I wasted paying all those premiums that increased so much each year. It became pretty obvious that when my employer, one of the largest banks in the world, negotiated with the health insurance companies, their retirees weren’t exactly at the top of their list of importance.

My doctor at The Villages Health went to undergraduate college with the president’s doctor, with Med school and residency in New York. But he is an MD, not like the prez’s DO.

[champion6]

I have Medicare and Freedom Health as a supplemental. Freedom has a zero dollar premium. I love my doctors. Primary care visit have no co pay and specialist at $20.
All of the medications that I take have no co pay.
I get $75 a month in over the counter products.
There is a maximum $3,000 per year out of pocket expense.
I am very happy with it.You have a Freedom Health Advantage plan. Freedom Health doesn't offer any Medicare Supplement plans.

The coverages you described are that of an advantage plan, not of Medicare + a supplement + a prescription drug plan.

Your Freedom Health plan has a zero dollar premium because you are paying a Medicare Part B premium and Medicare is paying Freedom Health.

Bottom line, I glad you are happy with it.

[jrieker68]

Definitely agree.... stay far away from any Advantage Plan. And not sure how old you are, but your supplemental premium is slightly higher when you do not sign up at 65. Some people think they will take an advantage plan at 65 because they are in very good health and want to save money. Then later they decide to switch to a supplemental and at that point they pay a higher premium due to age and any existing major health issues. Currently, can not be denied, but you pay more. I was in excellent health until a CT scan after a fall hiking they found a benign cyst in my abdomen which the hospital bill alone was over $73K, then a skin cancer that requires a plastic surgeon with repair under general anesthesia. I have Medicare, cost depends on your Adjustable Gross Income on your tax return from two years prior, plus Florida Blue Supplemental “F” Plan (Blue Cross Blue Shield) @ $202.30 a month , and I use WellCare Drug Plan for $13.20 a month. Tier 1 and Tier 2 drugs by mail order are free. Be sure to select the right drug plan, that is the hard part, but most of them you can enter each drug you may take and they will tell you what tier it falls under and the price. Never had surgery or been hospitalized except giving birth and now two in one year! I have been to the Mayo Clinic and paid zero. I have never found a Dr that did not accept my Medicare or supplemental. The Villages Health System use to accept Medicare & supplementals, then a couple of years ago, letters went out to all their patients saying they would now only accept Advantage plans. People were outraged and many left because they refused to give up their supplemental plans. The only down part of a supplemental is you are on your own for dental and most vision issues. Hope this helps.

I have the same plans - Florida Blue Plan F and Wellcare. Don't hesitate to get a different drug plan company. I was paying $77.20/mo. for Florida Blue drug plan and only $13.20 now with Wellcare. Don't pay anymore with Wellcare for drugs and I think it's actually less.

[Villagesgal]

I have medicare and AARP United Healthcare Plan F. Other than my premium I pay nothing, everything is 100% covered, do deductible, no copay. First time ever in hospital for minor operation, first time ever in ER, first time ever mri, paid not one penny. I have wellcare prescription plan, all generic, I pay nothing. I have children in 4 different states, have had to see drs there, no problem and no copays. Best is that I know exactly what my medical expenses will be each year, just premiums, so can easily budget never having to worry about a yearly maximum out of pocket. I attended a SHINE presentation, then a one on one. They will go over everything with you. They do not sell any insurance product. They give you all the information you need to decide what's best for you. I have had no problem at all finding doctors or hospitals who accept my plan, seems like they all accept my supplement. Depending on your birth year you may still be able to get Plan F if you were born in 1954 or earlier, if that's the case, you might consider going with that. Call SHINE, good luck. I don't think you can go wrong with Plan F or G.
I pay $182.70 per month for AARP United Healthcare Plan F, which is $2,192.49 per year, much less than most Advantage Plan yearly deductibles, and 13.00 for Wellcare drug plan for $156.00 per year, take 6 prescriptions and pay -0- per year for them.

[Miguel 1952]

You're going to be fine. Your research and thoughts are accurate. Find an independent agent, one who is reputable and been doing this for a while. They can walk you through the whole process quite easily. That person would have to evaluate your current drug list in addition to the supplement. Good luck!

This is exactly on point!
Independent agent is not obligated to just one insurance company, but can shop around.
There are many YouTube talks on Medicare, supplemental and Part D prescription. You can learned many things about Medicare so you know what questions to ask. My best!

[Pommom91]

I have Traditional Medicare with a blue cross supplement. I can go to any doctor in any state in the US if they participate in Medicare. I think the Villages Health care PCP’s are missing out by not accepting Medicare.

[Chi-Town]

Kathy,
I turned 65 in July and started Medicare. The government charges 144.00 a month. I took BC/BS plan G so I could see any doctor I wanted with a cost of 177.99 a month. I also had to find a company selling prescription plans and I selected SilverScript for 25.20 a month. Every doctor takes Medicare and plan G and I’m saving 200.00 a month from my private health care which had a 5000.00 deductible.

Very similar to my choices and couldn't be happier.

[chrisinva]

I understand your concerns. Ours were similar when we moved here 1.5 yrs. ago. We're both on Medicare. We went to a SHINE meeting for clarity. http://floridashine.org/ (http://floidashine.org/) and they cleared up everything. We still have my fed gov retiree coverage & Aetna instead of a supplemental Medicare plan. Works great - we never pay co-pays, can go to any doc, & pay very little for a few meds. Coverage is nation-wide.
Good luck - be sure to check out SHINE. Their in-person counseling is cancelled due to covid but they host virtual classes now.

[Eg_cruz]

I am currently insured through my husband's employer. Because it is a small company (30 - 40 employees?) my coverage is pricey. Also, like most people with private insurance, my deductible has quadrupled in the last few years. I have been reluctant to switch to Medicare but am currently investigating my options.

It looks as if I can save $200-300 per month on my premiums if I sign up for regular Medicare, a Plan G supplement, and a drug plan. In addition, if I am understanding what I read about Medi-gap plans, I will save several thousand dollars in annual out-of-pocket costs if I dump hubby's coverage.

Assuming that is correct (and please correct me if it is not!), my primary concern is: Will I have trouble finding doctors who accept my new coverage? Right now I can go to any doctor I want. If he/she is out of network I pay a larger percentage but I can still see that doctor.

I gather I will need to find another primary care dr if I make the switch because I have been seeing someone with TVHS. I have no attachment to that person, though, and have no problem with going elsewhere. BUT I'm terrified that something BAD will happen, everyone will say, "Oh, you MUST see Dr. So-and-So, he is the expert on that problem!" But Dr. So-and-So won't take Medicare patients.

Advice? Comments?

Thanks in advance.

kathy
If you go with AARP United Health Plan F you will see it is about the same price as Plan G. The difference is the part B deductible in Plane G you have to pay it and in Plan F you don’t.
If you are pretty healthy you may want to consider Plan N. Plan N it usually $50.00 less a month then the G and F. With N you have to pay the Part B deductible which is less than $200 a year and you have up to $20 co-pay to doctors. When it comes to Part A all three plans have the same coverage which is your hospital and short term nursing home.
With the N Plan you would have to go to the dr about 20 times a year before you reach the same out of pocket cost of G and F.
If you have other questions you can email.....FYI I do not sell any of the Medicare plans I have just worked in this market for 20 yrs. Happy to help

[condomom22]

Just this week I was told by a Medicare specialist (broker) that the Medicare/medigap (supplemental) policies allow for the greatest flexibility in doctors and hospitals (including Mayo) as these all accept Medicare. Additionally, the broker pointed out that with Advantage plans you are frequently directed to use only certain hospitals in their network for your surgery, whereas with Medicare/medigap you can select the hospital you wish to use.

[HappyRetired]

Plan F for supplemental insurance is no longer offered. If you have it, don't change. There are Advantage plans that are PPO (you can pick your doctor), not part of an HMO. However, some doctors don't take those plans. Add in costs of dental and eye care if they are not covered by supplemental. Some Advantage plans include some (limited) benefits. You must have drug coverage even if you don't use it or there is a penalty to pick up later. SHINE should be able to help. Also, set up an online account at Medicare.gov for lots of information on plans and Medicare in general. Do the same for Social Security because there are lots of questions answered there.

[sswitenki]

My husband and I came from MN with Medicare and BCBS Suppliment plans. My husband has had hospital stays at West Marion, ER trips to Villages hosp (never again), Leesburg hosp, Prostate Surg in Ocala, And total hip replacement At Mayo. He had PT and home health care after hip surgery. And a week stay in transitional care at Villages Rehab. All since Jan 1, 2019. We have paid zero copays, and Mayo only billed us about $100. Very happy with our plans. We have not had trouble finding mds but most have been specialists. Maybe general primary care is more difficult. Hubby needs internal med to help manage his needs

[sk450]

I don't think you can get plan G while still on privet insurance. If you were on Medicare you can use you husband's as a secondary. Your in or out of Medicare.

[airstreamingypsy]

It looks as if I can save $200-300 per month on my premiums if I sign up for regular Medicare, a Plan G supplement, and a drug plan. In addition, if I am understanding what I read about Medi-gap plans, I will save several thousand dollars in annual out-of-pocket costs if I dump hubby's coverage.

Kathy,

I have plan G. It's amazing. I have a one time deductible, under 200.00, and it's clear sailing after that.

[sk450]

Check with Mutual of Omaha with drug plan my total 132.00 per month.

[Bridget Staunton]

Just a note for all, Medicare is income driven. Love reading all the advise from everyone

[llmcdaniel]

My daughter is a PA for a large medical practice in Ohio. Every year during their annual discussion of financial strength a dr will suggest dropping Medicare pts, and everyone else dismisses that suggestion very quickly. It will never happen in most practices.

[kathyspear]

A big thanks to all who took time to respond. I really appreciate the info.

For those who asked, I am 69. At 65 I was automatically signed up for Part A and B but declined B as I was eligible to continue on hubby's work plan. At that time my deductible was $500; it is now 4k. My monthly premium is currently ~ $800 month and will likely go up (along with the deductible) in December or January.

Because hubs is still working full-time (and then some!) I will have to pay more than the typical $144 month. (I have already looked at the chart on the Medicare site which shows the premiums based on 2018 income to determine what my monthly payment will be.) I will also have to pay a surcharge for any drug plan. Even with those extra charges, it looks like I will come out way ahead.

As I said, my concern is my ability to see the doctors of my choice. I could have chosen a less expensive plan from hub's employer but I would have had a smaller pool of doctors in the network. Didn't want that restriction. I understand that some Advantage plans cover "extras" but I don't wear glasses (had cataract surgery with multi-focal lenses implanted), I currently pay as I go for dental (and I'm fine with that), and I know myself well enough to know I would never take advantage of a health club. :)

Again, thanks a million for the help.

k.

[Bridget Staunton]

Did you go to Shine presentation here in The Villages, thanks to advising others

[SharonW]

Ardith “Chere” Johnson at 352-746-0048
Independent agent who represents many companies.
Many factors in deciding right plan. Do you travel. Do you stay in Florida year round or go to another state part of year? Specialist like cancer care, heart doctors, kidney specialist, etc. An independent agent who represents many companies will help you make right decision.

[Bridget Staunton]

Thanks to all the posts advising others because I have questions too, great neighborhood

[FromDC]

A year before we signed up for Medicare, I attended many SHINE monthly meetings at Manatee Rec Center and also had a few one on one sessions with a SHINE rep. Very informative!

We signed up for original Medicare and the AARP UnitedHealthcare Plan F and have never regretted it.

As a new perk with UnitedHealthcare, as January 2020, we can use MVP Fitness for free through their Renew Active program. I have told many MVP members about this and they switched their paid account to FREE when they found out it. Just ask at the fitness desk. Sorry, don't know if Blue Cross qualifies. It's not just Advantage Plan members that get a free membership!

[Coley]

I am currently insured through my husband's employer. Because it is a small company (30 - 40 employees?) my coverage is pricey. Also, like most people with private insurance, my deductible has quadrupled in the last few years. I have been reluctant to switch to Medicare but am currently investigating my options.

It looks as if I can save $200-300 per month on my premiums if I sign up for regular Medicare, a Plan G supplement, and a drug plan. In addition, if I am understanding what I read about Medi-gap plans, I will save several thousand dollars in annual out-of-pocket costs if I dump hubby's coverage.

Assuming that is correct (and please correct me if it is not!), my primary concern is: Will I have trouble finding doctors who accept my new coverage? Right now I can go to any doctor I want. If he/she is out of network I pay a larger percentage but I can still see that doctor.

I gather I will need to find another primary care dr if I make the switch because I have been seeing someone with TVHS. I have no attachment to that person, though, and have no problem with going elsewhere. BUT I'm terrified that something BAD will happen, everyone will say, "Oh, you MUST see Dr. So-and-So, he is the expert on that problem!" But Dr. So-and-So won't take Medicare patients.

Advice? Comments?

Thanks in advance.

kathy


There are 2 types of medicare--Regular medicare and medicare advantage. With regular medicare and supplemental plans you can see any doctor that accepts medicare anywhere in the USA. Medicare advantage limits the doctors you can see to the ones in their system. Medicare advantage is much less expensive. If you choose medicare advantage and decide later to go back to regular medicare-they can underwrite your risk and could refuse to take you. One example would be if you got cancer and decided to go back to regular medicare so you could see a specific Dr who is not part of the Advantage program-they could refuse to accept you. Once your in regular medicare they can not cancel your coverage. Medicare advantage can not cancel your coverage either.
The real difference is the price of your premiums. Many take medicare advantage because it's a lot cheaper and their doctors are in the network so why not.
All medicare supplement plans(F,G,N,etc etc) differ in price only. The law states that plan F's benefits from one carrier cannot be any different from another carrier. Same with all the other plans(G,N etc etc). So one should shop price for the medicare supplemental plans that go with regular medicare.
Good luck with your decision.

[Marshaw]

We came from MN. We have united healthy care advantage. Our primary I'd the united health system. For specialties any doctor who takes Medicare is good. When traveling they have a passport for that purpose. The premium is 0. No copay for primary, 40 for specialist. It has optum for meds. Depending on which tier it's free. It's not through AARP which is good. Call shandy at focus pointe ins in lady lake. She is great to help you through.

[KRM0614]

I’d stay away from united healthcare, TV hospital Leesburg too go to Mayo. If you have good doctors up north keep them down here it’s a mediocre system

[jsd412]

I have been on Humana Advantage Plan for over 3 years. When I turned 65 and went on this plan I was in the middle of cancer treatment and reconstruction. I never had any issues finding GOOD doctors. I've been here in TV for little over a year and stayed Humana Gold Plus Advantage Plan. It covers GOOD doctors here locally as well as my specialists up at UF/Shands in Gainesville.

Do your homework. Check with your doctors if they take the different plans. Also, go on Nextdoor and ask people their experience with those plans.

Good Luck!

I am currently insured through my husband's employer. Because it is a small company (30 - 40 employees?) my coverage is pricey. Also, like most people with private insurance, my deductible has quadrupled in the last few years. I have been reluctant to switch to Medicare but am currently investigating my options.

It looks as if I can save $200-300 per month on my premiums if I sign up for regular Medicare, a Plan G supplement, and a drug plan. In addition, if I am understanding what I read about Medi-gap plans, I will save several thousand dollars in annual out-of-pocket costs if I dump hubby's coverage.

Assuming that is correct (and please correct me if it is not!), my primary concern is: Will I have trouble finding doctors who accept my new coverage? Right now I can go to any doctor I want. If he/she is out of network I pay a larger percentage but I can still see that doctor.

I gather I will need to find another primary care dr if I make the switch because I have been seeing someone with TVHS. I have no attachment to that person, though, and have no problem with going elsewhere. BUT I'm terrified that something BAD will happen, everyone will say, "Oh, you MUST see Dr. So-and-So, he is the expert on that problem!" But Dr. So-and-So won't take Medicare patients.

Advice? Comments?

Thanks in advance.

kathy

[KMcgee]

I am 66 and have Medicare plus AARP United Health Care as my supplemental Insurance plan ( F ). I have not had any problems with doctors accepting my Insurance and other than the monthly premiums for Medicare & AARP I have not had any out of pocket expenses ( Note this excludes Prescriptions which would be covered under Medicare Part ( D ). I believe that no matter what Part ( D ) Plan / Provider you choose you will have a monthly premium and some out of pocket expense for your medications. If you do not use many medications and are not on any specialty Medications the expense should be minimal. However if you are on alot of medications and any specialty medications you will likely have some significant out of pocket expense. Medicare provides an online tool to help estimate your annual medication expense. You should familiarize yourself with how Medicare Part ( D ) works and compare it against the coverage you are receiving from your Husbands plan and consider this in your decision making process. While you will not be able to use the Villages health for your primary care provider you can continue to use them for any Specialist that you may be seeing ( unless they changed this for 2021 ). Also I would like to clarify that Mayo Clinic does accept Medicare patients. However they do not accept Medicare assignment which means they will not accept the Medicare approved amount ( which is the amount medicare will pay your provider for a specific service / procedure ). Medicare allows Doctors / Hospitals that do not accept Medicare assignment to charge an additional 15% over the Medicare approved amount. Medicare Medigap Plan ( F ) covers this additional expense should you use a provider that does not accept Medicare assignment. Note for 2021 plan ( F ) is not being offerred to New Medicare clients so you should look at each of the
Medicare medigap plans ( A, B, C, D, G, K, L, M & N ) to see which one provides the level of coverage you desire. Again you can look at this online at Medicare.gov. Medicare is confusing and I would suggest that you speak with someone from SHINE to insure you have a full understanding prior to making any changes Finally here are some of the items and services Medicare doesn't cover:

Long-term care (also called custodial care )
Most dental care
Eye exams related to prescribing glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and exams for fitting them
Routine foot care

[Carla B]

Another thing, Kathy, since you didn't buy a Medigap plan when you turned 65, you may have to pay a penalty through slightly higher premiums for your Medigap Plan. That happened to us. We had insurance secondary to Medicare through his employment when we turned 65. It became very expensive and there were big balances to pay due to our living outside the network area. We never knew how much we'd end up owing, so even with the higher premium we had to pay for Medigap we felt it was worth it.

Somewhat of a negative, the premiums for Medigap with AARP were stable the first few years but now I'm dreading the annual letter raising the rates.

[massachusettskid]

Kathy my wife and I .moved here in June. My wife is 62 so I got a plan for her though Florida Blue.

I had Medicare plan F but I found a doctor who was virtual. I switched to The Village Health system and got United Health Care Advantage Plan 0 monthly payment very low deductible prescription,vision and dental.

I would suggest you contact the villages Shine representative who is an independent person to advise on health care issues. Good luck

Bob

[KittyKat]

I have Traditional Medicare with a blue cross supplement. I can go to any doctor in any state in the US if they participate in Medicare. I think the Villages Health care PCP’s are missing out by not accepting Medicare.

The Villages entered a contract with UHC so the PCP's have no choice.

[KittyKat]

Plan F for supplemental insurance is no longer offered. If you have it, don't change. There are Advantage plans that are PPO (you can pick your doctor), not part of an HMO. However, some doctors don't take those plans. Add in costs of dental and eye care if they are not covered by supplemental. Some Advantage plans include some (limited) benefits. You must have drug coverage even if you don't use it or there is a penalty to pick up later. SHINE should be able to help. Also, set up an online account at Medicare.gov for lots of information on plans and Medicare in general. Do the same for Social Security because there are lots of questions answered there.

I received an email from Medicare about checking out supplemental plans & clicked on a link after reading these posts. It directed me to UHC. I was born in 1953 but have been on disability since Dec 2000 & Medicare since Dec 2001. After I entered my info, all the plans showed up. I guess since I was already on Medicare when I turned 65, that has allowed me the ability to enroll in Plan F, etc. The monthly charge for Plan F, the most popular, is $202, Plan G--$177(?). It said the charge might change once I applied. I already have UHC for Part D coverage. In fact, I used to work for UHC in Ohio as a precertification nurse for outpt surgeries & skilled home care visits. What UHC Advantage Plan salespeople don't tell you is that the medical director of that office location can deny custodial care (mostly bathing) if patient is receiving skilled care even though Medicare pays for it if the patient is receiving skilled care (RN/PT/OT/ST) because it is THEIR plan. I used to sit one aisle over from these people & wanted to yell to the person on the phone "Don't do it!!!" Of course, this was in 1999 but I doubt if they have changed. Advantage plans sound great but are only good for people who are in good health.

[beccaboo**]

It was wonderful to see so many individuals take the time to respond to this important issue. After reviewing the responses, I would just like to add a few points of clarification:
1. You will not be penalized when you go onto Medicare Part B and buy your supplement, as you indicated you were under full coverage with your spouse's plan. This is considered creditable coverage and you do not then pay a penalty.
2. As was indicated, to select your Medicare Part D plan, the federal government does offer assistance. Go to the website, www.medicare.gov[/url], enter your data and sort results by cost of premium+ medication costs. Since this is a very individualized result, based upon your personal circumstances, do not just pick a company by a personal recommendation, as it may not be the most cost effective for you.
3. Review your Medicare Part D on an annual basis, during the open enrollment, which runs October 15th through December 7th. This is important because plans can change annually, new options can enter the market, providers can alter formularies and co-pays, premiums and out of pocket maximums can be adjusted annually.
4. When you select your Medicare Supplement, you will most likely remain with it ongoing, as you would generally be out of your Guaranteed Issue period ( the 6 months after you elect Medicare Part B) and changes can be more difficult to make.
5. Due to the MACRA (Medicare Access and CHIP Reauthorization Act) of 2015, Supplemental Plans C and F are not now available to newly eligible Medicare recipients. However, if you were eligible for Medicare prior to December 31, 2019, even if you were not yet enrolled in Medicare, you can still purchase a Plan C or F, as you are grandfathered into those programs.
6. While using an insurance broker may be a valuable tool for you in this process, you might want to ask how many companies they are able to broker with for your coverage, in comparison to you searching on the open market.
All the best in your search process.

[gail swanson]

You always give great info!

[jjombrello]

Had an AARP Medicare supplement plan with a drug plan for several years. Worked well both in Florida and elsewhere. Last year switched to an AARP Medicare Advantage Plan 2 (Regional PPO). Very happy with it. NO Premium. Have been able to go back to TVH system and can go to doctors out of state who accept this type of coverage. Out-of- network doctors and specialists may charge a higher fee but these are not prohibitive. With not paying any premium, the additional costs, if any, are affordable. Also comes with a drug plan that is equal to what I had before, again with no premium. When I signed up I specifically asked about coverage when travelling and was assured by UHC that this plan did cover when on the road.

[dstege]

Kathy,

Everyone who has given you advice regarding Medicare Supplement plans are all correct. Supplement plans have a monthly premium, and are accepted by all doctors and hospitals that accept Medicare throughout the country. You'll have no copays for doctors and hospitals, etc. (The Villages Health Primary Care do not accept Supps, but The Villages Specialists do). If you run a comparison on Medicare.gov it will give you a list of companies in our area, and the premium costs. You'll find AARP Medicare Supplement is the least expensive now. Because you are leaving your husband's plan, you would have a guarantee issue, so you don't have to worry about any health problems. I am an independent agent, specializing in Medicare plans since 2005, and would be happy to talk to you any time. 352-350-7135 Donna

[Mrprez]

Kathy,

Everyone who has given you advice regarding Medicare Supplement plans are all correct. Supplement plans have a monthly premium, and are accepted by all doctors and hospitals that accept Medicare throughout the country. You'll have no copays for doctors and hospitals, etc. (The Villages Health Primary Care do not accept Supps, but The Villages Specialists do). If you run a comparison on Medicare.gov it will give you a list of companies in our area, and the premium costs. You'll find AARP Medicare Supplement is the least expensive now. Because you are leaving your husband's plan, you would have a guarantee issue, so you don't have to worry about any health problems. I am an independent agent, specializing in Medicare plans since 2005, and would be happy to talk to you any time. 352-350-7135 Donna

When I tried to leave my wife’s FEPBlue plan for a Medigap plan F, I was denied due to underwriting. I have high BP and was prediabetic. This was in TN. I am not currently on any meds and have both issues under control. Would it be worth it to try again?

[Neils]

My advice. Go w medicare and good supplement (g is best)

Only limit in TV is on many primary care docs being locked in to the advantage deal. Specialists take reg medicare.
Plenty of primary care docs on perimeter of TV. Leesburg, Ocala. Not a big issue

[jblum315]

I got in trouble about 4 years ago by signing up for a medigap plan. I had to cancel my old Medicare supplement plan F in order to switch to new plan. Then I found that none of my present doctors would accept the new plan. It took me nearly 4 months to get back to the original plan, during that time I had no medical coverage at all. You have to be very careful in switching

[pkfavreau2]

I am starting Medicare today with plan G coverage (PPO) and WellCare for prescriptions. My friends who have it love it. I asked my doctors what they preferred and they all liked this one, widely accepted. $198 medical deductible then I should see no bills after the $435 deductible. Overall a great cost reduction for me. I went with the PPO, I just like the large network coverage in and out of state and no referrals required.

[PugMom]

Your hesitation is that you're afraid a doctor won't accept Medicare + supplemental. Have had Original Medicare + AARP for many years and have never encountered a practice that does not accept it, especially in Florida. Usually, when leaving the appointment, they say "You're good to go." No paperwork, no co-pay, you check in and walk out. Different than an Advantage plan.

There may be exceptions: I have the impression that Mayo Clinic may not accept Medicare plus supplemental as full payment, but I may be wrong about that. Maybe someone will clarify.
i can clarify a bit--i was taking my husband to mayo every other month. they will accept Medicare, but you will have to pay your portion promptly. they don't accept advantage plans, but his dr recommended a dr @ shands & another in ocala, both were covered.

[PugMom]

I suspect you will have plenty of choices, but the doctor I wanted for primary care would not accept new patients on Medicare, even though I had a referral from one of his patients who is a doctor also.

i have heard this too, but only when i lived in Ct., have not heard that down here,...yet

[Carla B]

I got in trouble about 4 years ago by signing up for a medigap plan. I had to cancel my old Medicare supplement plan F in order to switch to new plan. Then I found that none of my present doctors would accept the new plan. It took me nearly 4 months to get back to the original plan, during that time I had no medical coverage at all. You have to be very careful in switching

Did you mean to say you switched by signing up for an Advantage plan? Because Medigap plans are "supplement" plans (A, C, F, G, etc.) In other words, they pay the 20% difference between the 80% that Medicare pays and what you owe the doctor. I could see where you'd have trouble being reinstated to Plan F (Medigap) from an Advantage plan. That would be scary to have no insurance for four months at this age!

[dougjb]

For the best, unbiased info, go to SHINE. They have frequent meetings in The Villages (presumably virtual now). They are well worth your time and effort. Super knowledgeable!!

[dstege]

When I tried to leave my wife’s FEPBlue plan for a Medigap plan F, I was denied due to underwriting. I have high BP and was prediabetic. This was in TN. I am not currently on any meds and have both issues under control. Would it be worth it to try again?
Yes, Florida underwriting is not as extensive as other states. Plan F is no longer available. Plan G is the most benefit rich now. I can email you the Underwriting questions just to make sure. Just call and leave your email on my voicemail. If all the questions are "no", I would be happy to come to your home and meet with you all. 352-350-7135

[epoch]

When I tried to leave my wife’s FEPBlue plan for a Medigap plan F



you would rather have a supplement than FEHB?

[Mrprez]

you would rather have a supplement than FEHB?

The premiums are going up quite a bit. On a Self plus 1 plan, it costs me $271 a month to be the plus 1. Her cost is $175 a month. Then you add in Medicare Part B premiums times 2 and it all starts to add up quickly. We are both in excellent health and rarely go to a doctor.

[billethkid]

We have had traditional medicare plus a AARP supplement and have not had to reach in our pocket for anything other the premiums for over 20 years!!
Totally and complete satisfaction.

The ability to choose any doctors or specialists without approval or referrals is a very huge factor.

Coverage has been accepted anywhere and every where we have ever traveled to/from.