Medicare Supplement - Do Networks Apply?

[TVTVTV]

I am not yet eligible for Medicare, but will be early next year. Currently, my BCBS (FL Blue) individual Silver PPO medical insurance only covers specialists within the BCBS in-network list, so I am quite limited in my choices, and don't have my preferred specialist in the network. If I choose BCBS or any other supplement with original Medicare, am I understanding that as long as the specialist accepts original Medicare (which most do), that there is no more "in-network" to consider with a BCBS supplement? This would definitely widen the specialists I could see. I am specifically asking about supplements here, not advantage plans.

[villagetinker]

I am not yet eligible for Medicare, but will be early next year. Currently, my BCBS (FL Blue) individual Silver PPO medical insurance only covers specialists within the BCBS in-network list, so I am quite limited in my choices, and don't have my preferred specialist in the network. If I choose BCBS or any other supplement with original Medicare, am I understanding that as long as the specialist accepts original Medicare (which most do), that there is no more "in-network" to consider with a BCBS supplement? This would definitely widen the specialists I could see. I am specifically asking about supplements here, not advantage plans.

You need to contact SHINE ,
SHINE - Home (https://floridashine.org/),
as they will provide unbiased information that you need. They have on site meetings in TV at several rec centers. Very helpful people, and they saved us from making a very big mistake.

[retiredguy123]

Yes, if you have original Medicare, the Medicare supplement will cover you as long as the provider accepts original Medicare. The supplement is basically a piggyback plan for original medicare. There are no networks, like Medicare Advantage.

[Michael 61]

Looking forward to when I turn 65, and being able to get on traditional Medicare with a supplement, so I can get away from “networks” and having to seek out referrals to see a specialist.

[tophcfa]

I am not yet eligible for Medicare, but will be early next year. Currently, my BCBS (FL Blue) individual Silver PPO medical insurance only covers specialists within the BCBS in-network list, so I am quite limited in my choices, and don't have my preferred specialist in the network. If I choose BCBS or any other supplement with original Medicare, am I understanding that as long as the specialist accepts original Medicare (which most do), that there is no more "in-network" to consider with a BCBS supplement? This would definitely widen the specialists I could see. I am specifically asking about supplements here, not advantage plans.

Be careful with terminology, I have heard the term supplement referred to both as Medigap plans as well as Advantage plans. Be sure you avoid Advantage plans and focus in on Medigap plans if you want to be sure to avoid both networks and referrals. Advantage plans can appear to be both cheaper and to offer different types of fringe benefits, but we will all eventually all need some expensive medical care and not want to be constrained by networks, not have to seek out referrals, have to worry about what is covered, and have to sort through copay and deductible bills for our health care. In the long run, traditional Medicare with a Medigap and part D prescription policy are the best way to go. Best of luck with your decision.

[BigDawgInLakeDenham]

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

[mtdjed]

Be careful with terminology, I have heard the term supplement referred to both as Medigap plans as well as Advantage plans. Be sure you avoid Advantage plans and focus in on Medigap plans if you want to be sure to avoid both networks and referrals. Advantage plans can appear to be both cheaper and to offer different types of fringe benefits, but we will all eventually all need some expensive medical care and not want to be constrained by networks, not have to seek out referrals, have to worry about what is covered, and have to sort through copay and deductible bills for our health care. In the long run, traditional Medicare with a Medigap and part D prescription policy are the best way to go. Best of luck with your decision.

While I agree with the above, Supplements come at a price. My United Health Care Supplement Plan N comes at $185 per month and my Part D drug plan is $52/month. My former employer pays $1000 per year toward this expense.
Some folks can live within the networks and perhaps count the above expense as their savings.

For a family of two, having a supplement for two, that is a $4000 expense. That can mean a lot to some who are willing to contend with the network issue.

[MplsPete]

I don't know all the answers to your questions, but I wonder about some of your assumptions . . . Couple of years ago I was at an appointment with an ophthalmologist through my Advantage plan. She said she was retiring in a few months, and moving to Phoenix. She complained that most of the doctors in that area were full, and not accepting new patients. So, this belief, that you can see any MD who accepts original Medicare, may not be accurate. And in my experience, almost any medical professional has a full schedule for several weeks out or more. A primary doctor can get you in faster perhaps if they believe you need to be seen sooner. If my beliefs are accurate and widespread, your goals and means may not be realistic.

[BrianL99]

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now



There are really 2 choices in the Medicare world.

"Managed healthcare", where a provider manages your healthcare. An insurance company, who is in business to make a profit, is making your healthcare decisions.

Or "Self managed", where you yourself, directs your healthcare to your benefit.

It's a very simple equation. Who should be in charge of one's healthcare? A corporate entity, whose goal is to make profits or one's self, who's goal is to stay healthy and live a long and prosperous life?

Or, we could look it at another way. Name ONE "advantage" a Medicare Advantage Plan offers over a Medicare Supplemental plan, that isn't related to costs or "freebies".

It's a no brainer, unless financial constraints force you into a Medicare Advantage plan.

[rustyp]

There are really 2 choices in the Medicare world.

"Managed healthcare", where a provider manages your healthcare. An insurance company, who is in business to make a profit, is making your healthcare decisions.

Or "Self managed", where you yourself, directs your healthcare to your benefit.

It's a very simple equation. Who should be in charge of one's healthcare? A corporate entity, whose goal is to make profits or one's self, who's goal is to stay healthy and live a long and prosperous life?

Or, we could look it at another way. Name ONE "advantage" a Medicare Advantage Plan offers over a Medicare Supplemental plan, that isn't related to costs or "freebies".

It's a no brainer, unless financial constraints force you into a Medicare Advantage plan.

Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

[Dusty_Star]

Looking forward to when I turn 65, and being able to get on traditional Medicare with a supplement, so I can get away from “networks” and having to seek out referrals to see a specialist.

You are right. Big advantage. Can visit most doctors nationwide & if you need a specialist, you can see the one you want, where you want.

[Dusty_Star]

Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

I don't consider that an advantage at all. But to each his own.

[rustyp]

I don't consider that an advantage at all. But to each his own.

55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

[golfing eagles]

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

Absolutely 10000% true and well said. And that's from my perspective of providing primary care for 35 years.

[golfing eagles]

There are really 2 choices in the Medicare world.

"Managed healthcare", where a provider manages your healthcare. An insurance company, who is in business to make a profit, is making your healthcare decisions.

Or "Self managed", where you yourself, directs your healthcare to your benefit.

It's a very simple equation. Who should be in charge of one's healthcare? A corporate entity, whose goal is to make profits or one's self, who's goal is to stay healthy and live a long and prosperous life?

Or, we could look it at another way. Name ONE "advantage" a Medicare Advantage Plan offers over a Medicare Supplemental plan, that isn't related to costs or "freebies".

It's a no brainer, unless financial constraints force you into a Medicare Advantage plan.

Sorry, but I'm forced to disagree, and I probably know a bit more on the subject

The "insurance company" is NEVER "managing " your care under an advantage plan, it is primary care physician. Are there networks and limitations---yes, but it's easy to get an exception. In 35 years, not a single patient of mine was denied anything they needed anywhere they needed it. All that has to happen is that your primary care physician calls the medical director of the insurance plan. While I had a 100% success rate, I'm sure overall that rate is over 95% as long as the proper effort is put in. Remember, while that medical director is "safeguarding" the insurance co. $$$, they want absolutely no part in any decision that might adversely affect outcomes. Simply not worth the hassle for them, and the primary care physician will usually get an approval in 2 minutes.

As far as the second choice---"direct you own medical care", I cannot emphasize how bad an idea that is----kind of like deciding to build your own home nuclear reactor for cheap energy. Most often, it will blow up in your face. That is unless anyone thinks they can match 11+ years of medical education and years of experience by "googling" something. And surprisingly, there is a whole cadre of idiots who think they can do just that.

[OrangeBlossomBaby]

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

It's not about that. When you go to your regular physician for a problem, and the physician says you need a specialist, you need to know if you can afford to go to the specialist. Knowing whether your insurance covers specialists in your area, especially if your regular physician refers you to a specific one or group - is incredibly important.

Getting a PCP is a no-brainer. There are dozens and dozens of them, and you just have to pick one that accepts your insurance. There aren't dozens and dozens of specialists in each specialty, and many of them don't accept medicare at all.

For instance - I know I need a hip replacement. My PCP doesn't do those. I need a specialist for that. So when it was time for me to select my health insurance plan, I had to consider the cost of the hip replacement in mind. They run around $25,000 for people who don't have any insurance and aren't in a poverty level to get a break on the price. My insurance has super low premiums - only $17/month. No deductible. But an out of pocket expense max of $9700. That means - if I need a hip replacement THIS year, I'll pay $9700, instead of $25,000, and other medical expenses for the year won't cost anything at all.

If I don't need the hip replacement this year, then I'll pay my co-pays throughout the year when I go to the doctor, UNTIL I've paid out $9700, and then I'll pay no more til next year. Right now I'm racking up $85/DAY in expenses because I'm undergoing radiation treatments for skin cancer. My PCP doesn't provide that service, a specialist is handling that. That's the co-pay for specialist services on my plan.

I'm not on medicare yet, not old enough yet. But the explanation of "why" people are concerned about specialist access is the same no matter which type of health insurance you have.

[golfing eagles]

It's not about that. When you go to your regular physician for a problem, and the physician says you need a specialist, you need to know if you can afford to go to the specialist. Knowing whether your insurance covers specialists in your area, especially if your regular physician refers you to a specific one or group - is incredibly important.

Getting a PCP is a no-brainer. There are dozens and dozens of them, and you just have to pick one that accepts your insurance. There aren't dozens and dozens of specialists in each specialty, and many of them don't accept medicare at all.

For instance - I know I need a hip replacement. My PCP doesn't do those. I need a specialist for that. So when it was time for me to select my health insurance plan, I had to consider the cost of the hip replacement in mind. They run around $25,000 for people who don't have any insurance and aren't in a poverty level to get a break on the price. My insurance has super low premiums - only $17/month. No deductible. But an out of pocket expense max of $9700. That means - if I need a hip replacement THIS year, I'll pay $9700, instead of $25,000, and other medical expenses for the year won't cost anything at all.

If I don't need the hip replacement this year, then I'll pay my co-pays throughout the year when I go to the doctor, UNTIL I've paid out $9700, and then I'll pay no more til next year. Right now I'm racking up $85/DAY in expenses because I'm undergoing radiation treatments for skin cancer. My PCP doesn't provide that service, a specialist is handling that. That's the co-pay for specialist services on my plan.

I'm not on medicare yet, not old enough yet. But the explanation of "why" people are concerned about specialist access is the same no matter which type of health insurance you have.

Just one question: How did you get insurance for $17/month and no deductible when I've been paying $1600/month with a $7200 deductible (no health problems that would cause it to rated up)

[MX rider]

There are really 2 choices in the Medicare world.

"Managed healthcare", where a provider manages your healthcare. An insurance company, who is in business to make a profit, is making your healthcare decisions.

Or "Self managed", where you yourself, directs your healthcare to your benefit.

It's a very simple equation. Who should be in charge of one's healthcare? A corporate entity, whose goal is to make profits or one's self, who's goal is to stay healthy and live a long and prosperous life?

Or, we could look it at another way. Name ONE "advantage" a Medicare Advantage Plan offers over a Medicare Supplemental plan, that isn't related to costs or "freebies".

It's a no brainer, unless financial constraints force you into a Medicare Advantage plan.

We're on AARP UHC Advantage and love it. They have a huge nationwide network so it travels with you. We needed that since we're snowbirds.

We did a ton of research and even talked with people on this plan, which I doubt you did. We even talked to SHINE, they said it was a very good option for us. It's also highly rated by Medicare.
We love the wellness benefits as well.

You're painting with a broad brush, and you're not fully informed.
All advantage plans differ by a lot.

[tophcfa]

Just one question: How did you get insurance for $17/month and no deductible when I've been paying $1600/month with a $7200 deductible (no health problems that would cause it to rated up)

Obamacare income testing.

[tophcfa]

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

Whoever said patients with Medigap plans don’t have a PCP who helps them manage their health care? With a Medigap plan, if you need to see a specialist for a life altering condition, the PCP can refer to a top specialist in the USA, not whoever is practicing and accepting patients in your local network. If you happen to live in a rural area, there may not be an experienced specialist in your network, so you have to roll the dice with a generalist and hope for the best. Not optimal at all.
Also, with a part g Medigap plan, if that condition runs up a million dollars in medical expenses, all you pay is your approximately $250 annual deductible and never see another bill.

[Dusty_Star]

Getting a PCP is a no-brainer. There are dozens and dozens of them, and you just have to pick one that accepts your insurance. There aren't dozens and dozens of specialists in each specialty, and many of them don't accept medicare at all.



This article (September, 2023) says about 1% of physicians have opted out of Medicare, with the specialty of Psychiatry having the greatest number of opt-outs at 7%. It does vary slightly by state, with Florida being in the 1% to 1.5 % range.

How Many Physicians Have Opted Out of the Medicare Program? | KFF (https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/)

According to this very few physicians have opted-out of Medicare. Have you found this to be different in The Villages?

[retiredguy123]

Note that the OP's only question was, if they have original (traditional) Medicare and a Medicare supplement plan, is there a network of providers that they must use to be paid by the supplement plan? The question has already been answered and the answer is no. If the provider accepts traditional Medicare, then the supplement plan will cover all or part of the coinsurance.

[golfing eagles]

Note that the OP's only question was, if they have original (traditional) Medicare and a Medicare supplement plan, is there a network of providers that they must use to be paid by the supplement plan? The question has already been answered and the answer is no. If the provider accepts traditional Medicare, then the supplement plan will cover all or part of the coinsurance.

And since when does a definitive answer to a specific question end a thread on TOTV?:1rotfl::1rotfl::1rotfl:

[OrangeBlossomBaby]

Obamacare income testing.

It's a crappy plan. The basics are covered, I have to pay $85 per treatment, test, and specialist visit, and I have to keep paying that until I've hit $9700 out of pocket. That's just for me. Hubby has his own $9700 out of pocket, so the family benefit doesn't begin until we've eaten through $19,400 combined.

It's a Florida Blue bronze POS. And yes we're low income - not poverty though, or else we'd qualify for Medicaid. Last year the exact same plan was $187 premiums every month. I don't know why it went down so much this year but I'm not complaining. The year before, we were paying $267/month for a Silver plan.

[golfing eagles]

It's a crappy plan. The basics are covered, I have to pay $85 per treatment, test, and specialist visit, and I have to keep paying that until I've hit $9700 out of pocket. That's just for me. Hubby has his own $9700 out of pocket, so the family benefit doesn't begin until we've eaten through $19,400 combined.

It's a Florida Blue bronze POS. And yes we're low income - not poverty though, or else we'd qualify for Medicaid. Last year the exact same plan was $187 premiums every month. I don't know why it went down so much this year but I'm not complaining. The year before, we were paying $267/month for a Silver plan.

Amazing. I also have Florida Blue Bronze plan. $15,828/ month, single coverage, no significant health issues, $7,200 deductible and about $13,000 out of pocket max. Prescription meds run another $40/mo. Over the past 9 years I've put in about $110,000 into health insurance premiums and received back about $1.98 in benefits. Bottom line---better to be the insurer than the insured. At least I only have to pay April and May and then I'm on Medicare.

[BrianL99]

We're on AARP UHC Advantage and love it. They have a huge nationwide network so it travels with you. We needed that since we're snowbirds.

We did a ton of research and even talked with people on this plan, which I doubt you did. We even talked to SHINE, they said it was a very good option for us. It's also highly rated by Medicare.
We love the wellness benefits as well.

You're painting with a broad brush, and you're not fully informed.
All advantage plans differ by a lot.

No they don't "differ by a lot". They all have the exact same premise. The Insured doesn't get to control their medical services, the Insurer does and they're a profit making entity.

Advantage Plans are cheaper & give away "freebies" as you mentioned.

The fact that SHINE said "they're a very good solution for you, doesn't make them better or even equal to Medicare + a Supplemental. It means that in your particular financial/health position, it's a good option.

They're a cost based solution, for folks trying to save money. There's nothing else anyone needs to know about them.

[golfing eagles]

No they don't "differ by a lot". They all have the exact same premise. The Insured doesn't get to control their medical services, the Insurer does and they're a profit making entity.

Advantage Plans are cheaper & give away "freebies" as you mentioned.

The fact that SHINE said "they're a very good solution for you, doesn't make them better or even equal to Medicare + a Supplemental. It means that in your particular financial/health position, it's a good option.

They're a cost based solution, for folks trying to save money. There's nothing else anyone needs to know about them.

I thought I had dispelled that myth in post #15. Oh, well, this is TOTV after all:1rotfl::1rotfl::1rotfl:

[Caymus]

Amazing. I also have Florida Blue Bronze plan. $15,828/ month, single coverage, no significant health issues, $7,200 deductible and about $13,000 out of pocket max. Prescription meds run another $40/mo. Over the past 9 years I've put in about $110,000 into health insurance premiums and received back about $1.98 in benefits. Bottom line---better to be the insurer than the insured. At least I only have to pay April and May and then I'm on Medicare.

...and then you will meet "IRMMA".:D

[BigDawgInLakeDenham]

Sorry, but I'm forced to disagree, and I probably know a bit more on the subject

The "insurance company" is NEVER "managing " your care under an advantage plan, it is primary care physician. Are there networks and limitations---yes, but it's easy to get an exception. In 35 years, not a single patient of mine was denied anything they needed anywhere they needed it. All that has to happen is that your primary care physician calls the medical director of the insurance plan. While I had a 100% success rate, I'm sure overall that rate is over 95% as long as the proper effort is put in. Remember, while that medical director is "safeguarding" the insurance co. $$$, they want absolutely no part in any decision that might adversely affect outcomes. Simply not worth the hassle for them, and the primary care physician will usually get an approval in 2 minutes.

As far as the second choice---"direct you own medical care", I cannot emphasize how bad an idea that is----kind of like deciding to build your own home nuclear reactor for cheap energy. Most often, it will blow up in your face. That is unless anyone thinks they can match 11+ years of medical education and years of experience by "googling" something. And surprisingly, there is a whole cadre of idiots who think they can do just that.

:boom: WELL SAID BY AN EXPERT ON THIS TOPIC

:bigbow:

[BrianL99]

Sorry, but I'm forced to disagree, and I probably know a bit more on the subject

The "insurance company" is NEVER "managing " your care under an advantage plan, it is primary care physician.
...
While I had a 100% success rate, I'm sure overall that rate is over 95% as long as the proper effort is put in. Remember, while that medical director is "safeguarding" the insurance co. $$$, they want absolutely no part in any decision that might adversely affect outcomes. Simply not worth the hassle for them, and the primary care physician will usually get an approval in 2 minutes.

As far as the second choice---"direct you own medical care", I cannot emphasize how bad an idea that is----kind of like deciding to build your own home nuclear reactor for cheap energy. Most often, it will blow up in your face. That is unless anyone thinks they can match 11+ years of medical education and years of experience by "googling" something. And surprisingly, there is a whole cadre of idiots who think they can do just that.

I thought I had dispelled that myth in post #15. Oh, well, this is TOTV after all:1rotfl::1rotfl::1rotfl:


I'm not sure that anecdotal evidence, dispels anything. As with any business (& you surely know medicine has become a "business"), human nature and human competency, always trumps theory. In this case, the theory being that Advantage programs should be offering a level of medical care, consistent with other options. They all don't and at minimum, all depend on the competency, dedication and (your word) effort, of one's PCP.

As for "directing one's healthcare", I agree that folks shouldn't be relying on Google, but on a trusted, competent physician ... unencumbered by the corporate policy of a profit-making conglomerate.

(& I understand that Medicare has it's own standards and "rules", but manipulating and navigating Medicare rules, when the government is the overseer, seems much simpler to do, than negotiating/arguing/challenging/maneuvering through a structure controlled by competent, corporate America professionals.)

We can agree to disagree.

(& I'll bet a dollar, that the $1700/Month you're paying for your health insurance, with that huge deductible, allows you to see any physician you want and bet another dollar, it's a BCBS program!)

[rustyp]

No they don't "differ by a lot". They all have the exact same premise. The Insured doesn't get to control their medical services, the Insurer does and they're a profit making entity.

Advantage Plans are cheaper & give away "freebies" as you mentioned.

The fact that SHINE said "they're a very good solution for you, doesn't make them better or even equal to Medicare + a Supplemental. It means that in your particular financial/health position, it's a good option.

They're a cost based solution, for folks trying to save money. There's nothing else anyone needs to know about them.

Most likely when you disclose to Shine your employer is paying for your supplement as part of your retirement package they will probably recommend medicare plus a supplement.

[tophcfa]

Amazing. I also have Florida Blue Bronze plan. $15,828/ month, single coverage, no significant health issues, $7,200 deductible and about $13,000 out of pocket max. Prescription meds run another $40/mo. Over the past 9 years I've put in about $110,000 into health insurance premiums and received back about $1.98 in benefits. Bottom line---better to be the insurer than the insured. At least I only have to pay April and May and then I'm on Medicare.

I have the Massachusetts Blue Bronze and pay about the same as you and am counting the days until turning 65. There is only one reason I’m happy to be getting older, healthcare.

[Dusty_Star]

I have the Massachusetts Blue Bronze and pay about the same as you and am counting the days until turning 65. There is only one reason I’m happy to be getting older, healthcare.

Well, I'm happy to be getting older, because I don't care for the alternative. :smiley:

[MX rider]

No they don't "differ by a lot". They all have the exact same premise. The Insured doesn't get to control their medical services, the Insurer does and they're a profit making entity.

Advantage Plans are cheaper & give away "freebies" as you mentioned.

The fact that SHINE said "they're a very good solution for you, doesn't make them better or even equal to Medicare + a Supplemental. It means that in your particular financial/health position, it's a good option.

They're a cost based solution, for folks trying to save money. There's nothing else anyone needs to know about them.

You make a lot of assumptions, our decision was not cost based. We think our plan is best for us. It's not a one size fits all thing as you seem to be saying. Having options is a good thing.

I'll defer to Golfing Eagles, who by the way is a healthcare provider. I actually asked my longtime pcp in Indiana about this as well, he basically echoed golfing eagles.

Your commenting on something you really aren't up to speed on.
Again, how much actual research have you done on ALL the different advantage plans?
Btw, I know what SHINE was saying. Duh.

My point is you're trying to say all advantage plans are bad, and that's just flat wrong.
Over 50% of new medicare enrollees opt for advantage plans. Thats a lot of people. I don't think they're just blindly going that route for cost alone. I'm sure many did their homework and research just like we did.

But we can agree to disagree on this.

[BrianL99]

I have the Massachusetts Blue Bronze and pay about the same as you and am counting the days until turning 65. There is only one reason I’m happy to be getting older, healthcare.

Yeah, I waited years to get my free Medicare, until I found out it costs me over $630/month. That took some of the fun out of turning 65.

[BigDawgInLakeDenham]

Whoever said patients with Medigap plans don’t have a PCP who helps them manage their health care? With a Medigap plan, if you need to see a specialist for a life altering condition, the PCP can refer to a top specialist in the USA, not whoever is practicing and accepting patients in your local network. If you happen to live in a rural area, there may not be an experienced specialist in your network, so you have to roll the dice with a generalist and hope for the best. Not optimal at all.
Also, with a part g Medigap plan, if that condition runs up a million dollars in medical expenses, all you pay is your approximately $250 annual deductible and never see another bill.

How do you think a Physician becomes a "Specialist"? All Physicians are specialists in their area of practice that they spent many years of hands on training and even if they are in a shanty in East Bumfudge Egypt they're prepared to care for you. The variables here are people aka patients. Patients have no patience #1. Patients only think they are the one that matters because they only present in their time of need and expect immediate attention. Do you really believe that you're going to see a specialist while on vacation just because you want to? There are Patients that have never experienced pain, like the pain after hip or knee surgery. They transfer this pain onto the doctor because they may think another doctor could have done the surgery without postoperative pain. This false belief becomes a negative review of the doctor. They may never achieve full range of motion in their hip or knee because of the postoperative pain involved in physical therapy exercises and these exercises are the key to a successful joint replacement...... but this is not the doctor's fault yet the review will say it's the doctor's fault that the patient didn't complete PT. I could go on and on about people's distorted views of reality in the Healthcare system. Maybe you're saying that when you get cancer you're traveling to a big name hospital because you'll accept no less. Many affluent people do and it has sometimes worked out in the past. I will tell you that I'm coming from a recognized name in medicine and have seen that all hospitals bottom line is what's most important. The care environment in the hospital is dwindling since Covid, George Floyd and the nationwide HR push for diversity and inclusion. Recruitment and retention of quality patient care staff is more difficult as each day passes. Covid knocked out many quality caring Healthcare workers. If you remember, we HAD to work and it was a horrific time which led to many leaving the industry or seeking work outside hospitals. Don't be surprised now if your Nurse looks like Jellyroll with a nasty attitude. It pains me to say this because I poured my heart and soul into quality patient care because I loved the people we served and I loved my job and my coworkers. I can't say that to be so anymore and I'd be hesitant to jet off to a big name unless I needed a specialist and they were the only one, as Dr Ben Carson was. You're relationship with the doctor is paramount but hospital stays can taint your entire experience.

I'm ranting but there's a lot more to this than which insurance you pick. After my experiences and my knowledge base I don't have any problem with having a Villages UC Advantage Plan with HMO or PPO or AARP Advantage Plan. Not looking for the "freebies", but instead I feel confident that between what I know to be fact and a solid relationship with a PCP, I can get everything in Healthcare that I will need.

BrianL99....I've never had a PCP that worked for an insurance company. Physicians pick and choose which insurance companies they want to associate with after reading all the fine print. They choose to accept insurances that will let them operate with reasonable reimbursement while allowing their patients good benefits coverage. And then there's my Dermatologist that stopped taking Medicare patients because the reimbursement is so low and she wanted a bigger yacht and another rental property....true story

[golfing eagles]

I'm not sure that anecdotal evidence, dispels anything. As with any business (& you surely know medicine has become a "business"), human nature and human competency, always trumps theory. In this case, the theory being that Advantage programs should be offering a level of medical care, consistent with other options. They all don't and at minimum, all depend on the competency, dedication and (your word) effort, of one's PCP.

As for "directing one's healthcare", I agree that folks shouldn't be relying on Google, but on a trusted, competent physician ... unencumbered by the corporate policy of a profit-making conglomerate.

(& I understand that Medicare has it's own standards and "rules", but manipulating and navigating Medicare rules, when the government is the overseer, seems much simpler to do, than negotiating/arguing/challenging/maneuvering through a structure controlled by competent, corporate America professionals.)

We can agree to disagree.

(& I'll bet a dollar, that the $1700/Month you're paying for your health insurance, with that huge deductible, allows you to see any physician you want and bet another dollar, it's a BCBS program!)

You'd win both bets, but I can't pay up since I'm spending 100x as much each month as OBB. (Actually, I think she owes me a thank you for subsidizing her premium:1rotfl::1rotfl::1rotfl:)

But then riddle me this: With all my expertise, I get Medicare in 2 months and have already signed up for my advantage plan. Am I stupid? Ignorant? Gullible? (on second thought, don't answer that:1rotfl::1rotfl::1rotfl:)

[Pugchief]

@golfing eagles and @BigDawgInLakeDenham thanks for your opinion. I, too, spent my entire career in health care delivery and have the opposite view: I would NEVER sign up for an HMO of any kind, including Medicare Advantage unless it was my only option. Yes, you will save some money. But you will also jump thru more hoops to go anywhere beyond PCP, and I have also heard horror stories of people being denied care they wanted/needed by the HMO. I'm sure it is a good option for many folks, but definitely not me.

[BigDawgInLakeDenham]

@golfing eagles and @BigDawgInLakeDenham thanks for your opinion. I, too, spent my entire career in health care delivery and have the opposite view: I would NEVER sign up for an HMO of any kind, including Medicare Advantage unless it was my only option. Yes, you will save some money. But you will also jump thru more hoops to go anywhere beyond PCP, and I have also heard horror stories of people being denied care they wanted/needed by the HMO. I'm sure it is a good option for many folks, but definitely not me.

It's your prerogative to pay more for the same or less....but please do share your knowledge of horror stories of people not getting what they actually need. It's not reported by any news media so I for one would love to hear how insurance killed subscribers. It will be interesting to analyze if the insurance actually denied necessary procedures without being litigated and responsible for harm.

What kinda of Healthcare worker were you? I'm curious why you fear navagating the system and why you believe insurance companies like United Health Care are evil while the Government is your best friend. I've shocked folks back to life but I've also prepared them for a family viewing and a body bag. I've worked with my orthopedic surgeon on the Trauma Team, when he was a resident, years before having him do my surgery only because of the great respect I had for him and his wonderful humanity. Being a Healthcare Professional does help me navigate the system because I was part of it and I also helped family members to the end of their lives. I've buried my parents, my Brother, my Sister, and most recently my Daughter of 27 years. They all had everything they needed and HMOs were never an issue.

As a Frontline Healthcare Worker that participated in lifesaving procedures I had a HMO my entire Adult life and I have never been denied and I've never had to spend A LOT out of pocket and I've seen many "Specialists" without ever seeing a "Hoop". Can you explain how I pulled this off having the evil managed care insurance? I had bilateral knee replacements and my copay was $100. I won't get that much of a discount on an Advantage Plan because that was a benefit of my Employer's plan but withThe Villages United Healthcare Plan my out of pocket maximum for the year would be $2700, even if I had a $100,000 procedure, and that's with no monthly cost........talk about a freebie.....but to each his own..... I'm done

[Rainger99]

Amazing. I also have Florida Blue Bronze plan. $15,828/ month, single coverage, no significant health issues, $7,200 deductible and about $13,000 out of pocket max.

$15,828/ month!! That would be $189,936 a year!!

Please tell me that is a typo!

[CoachKandSportsguy]

@golfing eagles and @BigDawgInLakeDenham thanks for your opinion. I, too, spent my entire career in health care delivery and have the opposite view: I would NEVER sign up for an HMO of any kind, including Medicare Advantage unless it was my only option. Yes, you will save some money. But you will also jump thru more hoops to go anywhere beyond PCP, and I have also heard horror stories of people being denied care they wanted/needed by the HMO. I'm sure it is a good option for many folks, but definitely not me.

Correct, currently BCBS MA is denying paying for cancer validating exam requested by one of CoachK's direct report's husband's doctors, who is forced to go onto Medicare to get the $7,000 validating exam paid for. . private employer provided insurance refused to pay. . .

Unfortunately, there are hospitals which has stopped taking UHC insurance plans as they don't pay promptly or at all. . another friend who's wife has been a nurse in administration for her whole life, had to switch to medicare to get his doctors' requests paid for after this heart by-pass operation which saved his life.

times are changing, and UHC is profit over patient. . don't believe anything to the contrary with UHC

Advantage plans only work for the healthy with no issues. . and when you do have issues, be sure they are regular everyday issues. .

[mtdjed]

[QUOTE=OrangeBlossomBaby;2305950]It's a crappy plan. The basics are covered, I have to pay $85 per treatment, test, and specialist visit, and I have to keep paying that until I've hit $9700 out of pocket [QUOTE]

I have had two episodes of skin cancer each requiring 22 daily treatments.

My only co pay was the initial diagnosis. There were no copays for the subsequent daily treatments. Do different providers have different options regarding copays or is it the insurance plan that determines that? I'm on regular Medicare with a Supplement Plan N. My plan has a $20 copay.

[BigDawgInLakeDenham]

Correct, currently BCBS MA is denying paying for cancer validating exam requested by one of CoachK's direct report's husband's doctors, who is forced to go onto Medicare to get the $7,000 validating exam paid for. . private employer provided insurance refused to pay. . .

Unfortunately, there are hospitals which has stopped taking UHC insurance plans as they don't pay promptly or at all. . another friend who's wife has been a nurse in administration for her whole life, had to switch to medicare to get his doctors' requests paid for after this heart by-pass operation which saved his life.

times are changing, and UHC is profit over patient. . don't believe anything to the contrary with UHC

Advantage plans only work for the healthy with no issues. . and when you do have issues, be sure they are regular everyday issues. .

Sorry but your story is BS. If RN wife switched to Medicare it has no impact and no coverage for anyone but her. Please provide factual personal experiences...please

Oh and mine is a Nurse Administrator and I would not want her to run my code

[BigDawgInLakeDenham]

Correct, currently BCBS MA is denying paying for cancer validating exam requested by one of CoachK's direct report's husband's doctors, who is forced to go onto Medicare to get the $7,000 validating exam paid for. . private employer provided insurance refused to pay. . .

Unfortunately, there are hospitals which has stopped taking UHC insurance plans as they don't pay promptly or at all. . another friend who's wife has been a nurse in administration for her whole life, had to switch to medicare to get his doctors' requests paid for after this heart by-pass operation which saved his life.

times are changing, and UHC is profit over patient. . don't believe anything to the contrary with UHC

Advantage plans only work for the healthy with no issues. . and when you do have issues, be sure they are regular everyday issues. .

You are Soooo wrong. So so wrong. I'm not going to reveal my PHI to make you look stupid....but....

[CoachKandSportsguy]

Sorry but your story is BS. If RN wife switched to Medicare it has no impact and no coverage for anyone but her. Please provide factual personal experiences...please

Oh and mine is a Nurse Administrator and I would not want her to run my code

nice try , I didn't give you any fine details, but yes, both stories are very very true for both nurse wives and husbands scenarios who work/worked at hospitals. Sorry, I can't give you names to counter your response for your assumed all knowing knowledge as well as highly judgmental typing.

but continue on, we will hang on every word you type. . .

[BrianL99]

You'd win both bets, but I can't pay up since I'm spending 100x as much each month as OBB. (Actually, I think she owes me a thank you for subsidizing her premium:1rotfl::1rotfl::1rotfl:)

But then riddle me this: With all my expertise, I get Medicare in 2 months and have already signed up for my advantage plan. Am I stupid? Ignorant? Gullible? (on second thought, don't answer that:1rotfl::1rotfl::1rotfl:)

I know you're not stupid, nor gullible. I'm fairly certain we played golf together last month. I would have noticed those traits.

Obviously you're not the typical "patient" or insured, now are you? I suspect you signed up for an Advantage Plan, because you like the convenience and availability of The Villages Healthcare system and you're reasonably young and healthy.

[MX rider]

nice try , I didn't give you any fine details, but yes, both stories are very very true for both nurse wives and husbands scenarios who work/worked at hospitals. Sorry, I can't give you names to counter your response for your assumed all knowing knowledge as well as highly judgmental typing.

but continue on, we will hang on every word you type. . .

You can't say all advantage plans are bad, anymore than you can say all doctors are good. You're totally avoiding all the posts from people that have UHC, have used it and like it.

As I've said, we did a ton of research and even talked to people on the plan. And no, they weren't all healthy.
SHINE said the UHC plan is very good, plus it's one of the highest rated advantage plans by Medicare.

Btw, my plan does not need pre-approvals for specialists.

Having choices is a good thing. There's no one size fits all.
But I guess you think the over 50% that choose advantage plans are not smart and only care about cost? Sure, some only look at cost, but I would argue many of them are like us, they did their research and made an educated decision.

[MX rider]

Correct, currently BCBS MA is denying paying for cancer validating exam requested by one of CoachK's direct report's husband's doctors, who is forced to go onto Medicare to get the $7,000 validating exam paid for. . private employer provided insurance refused to pay. . .

Unfortunately, there are hospitals which has stopped taking UHC insurance plans as they don't pay promptly or at all. . another friend who's wife has been a nurse in administration for her whole life, had to switch to medicare to get his doctors' requests paid for after this heart by-pass operation which saved his life.

times are changing, and UHC is profit over patient. . don't believe anything to the contrary with UHC

Advantage plans only work for the healthy with no issues. . and when you do have issues, be sure they are regular everyday issues. .

Yes UHC is for profit. So are most hospitals, clinics and every doctor I've ever known.

Just because it's for profit doesn't make it a bad choice. Medicare is not a one size fits all.

[tophcfa]

Yeah, I waited years to get my free Medicare, until I found out it costs me over $630/month. That took some of the fun out of turning 65.

Ya, Medicare, Medigap, and Pard D prescription is going to cost my wife and I about $800 per month for great national coverage with about a $250 max out of pocket each per year. We now pay over twice that for our Obamacare plan with a limited local network and about $8,000 max out of pocket each per year. That makes Medicare look dam good compared to our current options.

[golfing eagles]

$15,828/ month!! That would be $189,936 a year!!

Please tell me that is a typo!

$1588/mo. sorry.

[golfing eagles]

@golfing eagles and @BigDawgInLakeDenham thanks for your opinion. I, too, spent my entire career in health care delivery and have the opposite view: I would NEVER sign up for an HMO of any kind, including Medicare Advantage unless it was my only option. Yes, you will save some money. But you will also jump thru more hoops to go anywhere beyond PCP, and I have also heard horror stories of people being denied care they wanted/needed by the HMO. I'm sure it is a good option for many folks, but definitely not me.

The Plan I signed up for is a PPO, not an HMO. Big difference

[OrangeBlossomBaby]

Ya, Medicare, Medigap, and Pard D prescription is going to cost my wife and I about $800 per month for great national coverage with about a $250 max out of pocket each per year. We now pay over twice that for our Obamacare plan with a limited local network and about $8,000 max out of pocket each per year. That makes Medicare look dam good compared to our current options.

For us, once we're on Medicare, our premiums will be higher than they are now because of our subsidies on the ACA marketplace. On the other hand, if we didn't have subsidies, we'd have to pay around $1800/month for insurance. That'd eat up one of our social security checks every month, and dip into another one by a few bucks. We'd have to do without insurance at all and just hope that we never need health care.

We paid in all our lives for Medicare, did everything we were supposed to do, but circumstances forced us into a much more modest retirement income than we were expecting.

To whoever was asking about co-pays - it's insurance-dependent. You pay whatever your insurance company says you pay. Mine says $85 per treatment, per specialist visit, per lab test. So treating my skin cancer will set us back around $2800, over a 6-week period Including the test/biopsy, consultation for treatment, weekly 10-second visit with the doctor who walks in, doesn't even come within 5 feet of me, says "looks good, see you next week" and walks out again. INFURIATING that they even have the right to bill anyone for that.

[westernrider75]

Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

But there are many doctors here not associated with that plan that accept original Medicare. I for one have had no problems finding doctors since moving here full time and I have original Medicare.

[westernrider75]

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

My only experience with an advantage plan was when both my parents, at separate times, needed to be in a nursing home. Because they had an advantage plan our choices were extremely limited where they could go, there were only 2 choices and neither were great. But those were the only homes that would accept their advantage plan.

[bowlingal]

talk to the people at SHINE- Serving Health Insurance Needs of Elders. They are Medicare people, NOT insurance people. Also, for your Part D, look into Wellcare. I just changed and have no premium and no charge for medications ( tier 1).

[bragones]

Yeah, I waited years to get my free Medicare, until I found out it costs me over $630/month. That took some of the fun out of turning 65.

Sounds like you need a way to bring your income down. If that's the case, think growth stocks that don't pay a dividend.

[dolphin]

I am not yet eligible for Medicare, but will be early next year. Currently, my BCBS (FL Blue) individual Silver PPO medical insurance only covers specialists within the BCBS in-network list, so I am quite limited in my choices, and don't have my preferred specialist in the network. If I choose BCBS or any other supplement with original Medicare, am I understanding that as long as the specialist accepts original Medicare (which most do), that there is no more "in-network" to consider with a BCBS supplement? This would definitely widen the specialists I could see. I am specifically asking about supplements here, not advantage plans.

Keep your plan if iu can afford. Excellent

[biker1]

Yep. With Medicare and a Supplemental Plan (say Plan G, Plan N would be a bit less), you will pay about $8000 per year for the two of you but typically nothing more (after the Part B deductible and there can be copays with Plan N). With an Advantage Plan, you will pay about $4000 per year for the two of you but it could be more depending on what services you need and the Advantage Plan. For me, being on Medicare saved me money. For you, it may cost you additional money. Funny how that works.

For us, once we're on Medicare, our premiums will be higher than they are now because of our subsidies on the ACA marketplace. On the other hand, if we didn't have subsidies, we'd have to pay around $1800/month for insurance. That'd eat up one of our social security checks every month, and dip into another one by a few bucks. We'd have to do without insurance at all and just hope that we never need health care.

We paid in all our lives for Medicare, did everything we were supposed to do, but circumstances forced us into a much more modest retirement income than we were expecting.

To whoever was asking about co-pays - it's insurance-dependent. You pay whatever your insurance company says you pay. Mine says $85 per treatment, per specialist visit, per lab test. So treating my skin cancer will set us back around $2800, over a 6-week period Including the test/biopsy, consultation for treatment, weekly 10-second visit with the doctor who walks in, doesn't even come within 5 feet of me, says "looks good, see you next week" and walks out again. INFURIATING that they even have the right to bill anyone for that.

[Eclas]

I currently have medicare and federal bcbs as my supplement. So I have my own primary care doctor and if I know I need a specialist I can go thru my primary or just go direct to the specialist. The only restriction for me is the doc has to be in the bcbs network. I have not had any problems with that.

[Marine1974]

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now
I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist. .

[Indydealmaker]

Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

How is that particularly good?

[MX rider]

I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist. .

Your last sentence is not true. My advantage plan does not require this at all. I just used it to go to a specialist.

[Indydealmaker]

55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

Just a marketing concept. Your healthcare is dictated by the profits. Advantage companies don't make money if you require more care than your allotment. Logic says that must effect the care.

[TVTVTV]

Note that the OP's only question was, if they have original (traditional) Medicare and a Medicare supplement plan, is there a network of providers that they must use to be paid by the supplement plan? The question has already been answered and the answer is no. If the provider accepts traditional Medicare, then the supplement plan will cover all or part of the coinsurance.

Thank you to the few of you who answered my direct question. I wasn't looking for advice on every other aspect of health care, just a direct inquiry if "in network" and "out of network" exists with any Medicare supplement (= Medigap). I have a great PCP that I see regularly. I have done a lot of reading on Medicare, and will be in contact with SHINE. I know everyone's situation is different, so what fits my needs may not be the choice for someone else. Since PCP's and specialists may move or join another company, they may be in an Advantage plan one year and not the next. When I am faced with a medical crisis, I want to decide where in the country I want my treatment. For example, there don't seem to be any Advantage plans locally that would permit me to go to the Mayo Clinic if that's where my PCP said had the best treatment. I'd have to use an "in-network" provider that may not be my preference. (If there is one, no need to tell me which one). This is just an example, and could apply if you wanted to go somewhere with advanced treatment options for a myriad of health issues.

I really appreciate your direct answer to my general question, which was if I choose a specific company (like FL Blue or UHS) SUPPLEMENT, then I can go anywhere and see any PCP or specialist (yes, if they are accepting new patients, etc.), as NETWORKS don't apply with supplement (medigap) plans, but do with Advantage Plans. I will continue to research.

[rustyp]

How is that particularly good?

About The Villages Health - The Villages Health (https://thevillageshealth.com/about/)

[biker1]

Just in case you didn't realize, all of the Supplemental Plans are identical in terms of coverage. In other words, one insurance company's Plan G is identical to another insurance company's Plan G. The cost, however, will vary. In addition, some of the insurance companies may allow you change from one plan to another (say move from Plan G to Plan N) without going through underwriting. For example, UHC in Florida allows this.

Thank you to the few of you who answered my direct question. I wasn't looking for advice on every other aspect of health care, just a direct inquiry if "in network" and "out of network" exists with any Medicare supplement (= Medigap). I have a great PCP that I see regularly. I have done a lot of reading on Medicare, and will be in contact with SHINE. I know everyone's situation is different, so what fits my needs may not be the choice for someone else. Since PCP's and specialists may move or join another company, they may be in an Advantage plan one year and not the next. When I am faced with a medical crisis, I want to decide where in the country I want my treatment. For example, there don't seem to be any Advantage plans locally that would permit me to go to the Mayo Clinic if that's where my PCP said had the best treatment. I'd have to use an "in-network" provider that may not be my preference. (If there is one, no need to tell me which one). This is just an example, and could apply if you wanted to go somewhere with advanced treatment options for a myriad of health issues.

I really appreciate your direct answer to my general question, which was if I choose a specific company (like FL Blue or UHS) SUPPLEMENT, then I can go anywhere and see any PCP or specialist (yes, if they are accepting new patients, etc.), as NETWORKS don't apply with supplement (medigap) plans, but do with Advantage Plans. I will continue to research.

[MX rider]

Just a marketing concept. Your healthcare is dictated by the profits. Advantage companies don't make money if you require more care than your allotment. Logic says that must effect the care.

You're making assumptions. Btw, doctors and hospitals are for profit. Advantage plans aren't for everyone, but they're a good option. Choice is a good thing.

[Kittyjohn]

Please check with SHINE. There are also secondary policies such as may be offered along w Medicare from a previous employer. Other rules such as networks etc may apply.

[rustyp]

55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

Just a marketing concept. Your healthcare is dictated by the profits. Advantage companies don't make money if you require more care than your allotment. Logic says that must effect the care.

Apparently 55000 patients in TVHS have yet to require more care than their allotment or they would be heading for the exit. FYI 2023 53% of all Medicare eligible seniors are enrolled in an Advantage plan.

Do not interpret my position as an Advantage plan is better or worse than Medicare with a supplement. I have had both. Both worked equally well for me. I went with the Advantage plan due to my desire to be in TVHS. Have you been in enrolled in both or are you speaking as an internet surfer ?

[TVTVTV]

Just in case you didn't realize, all of the Supplemental Plans are identical in terms of coverage. In other words, one insurance company's Plan G is identical to another insurance company's Plan G (based on county you live in). The cost, however, will vary. In addition, some of the insurance companies may allow you change from one plan to another (say move from Plan G to Plan N) without going through underwriting. For example, UHC in Florida allows this.

Yes, thanks for the reminder of that. So for example, all G Supplements have = and identical coverage, and your choice is the company and price (based on the county you live in). With Advantage plans, you need to consider more: company, price, specific coverage and co-pays, possible perks, perhaps specific Rx sites you can use, and most importantly, the PCP's, specialists, and facilities you have in-network when you need health care.

[retiredguy123]

Yes, thanks for the reminder of that. So for example, all G Supplements have = and identical coverage, and your choice is the company and price (based on the county you live in). With Advantage plans, you need to consider more: company, price, specific coverage and co-pays, possible perks, perhaps specific Rx sites you can use, and most importantly, the PCP's, specialists, and facilities you have in-network when you need health care.
Note that Medicare supplement plans for traditional Medicare are not really health insurance plans at all. They rely exclusively on the Government to review and approve claims submitted by providers of Medicare services. If the claim is approved, then the supplement plan will pay all or part of the coinsurance as specified in the plan. If the claim is rejected, the supplement plan will pay nothing. So, for them, it is just a math calculation.

[Dusty_Star]

Yes, thanks for the reminder of that. So for example, all G Supplements have = and identical coverage, and your choice is the company and price (based on the county you live in). With Advantage plans, you need to consider more: company, price, specific coverage and co-pays, possible perks, perhaps specific Rx sites you can use, and most importantly, the PCP's, specialists, and facilities you have in-network when you need health care.

Teeny, tiny bit more complicated, you also purchase Plan D for drug coverage, & that choice will dictate pharmacies, but I think they also allow you to choose online or mail in pharmacies. Anyone know better, please chime in.

[retiredguy123]

Teeny, tiny bit more complicated, you also purchase Plan D for drug coverage, & that choice will dictate pharmacies, but I think they also allow you to choose online or mail in pharmacies. Anyone know better, please chime in.
I think you are referring to Medicare Part D, not Plan D. Part D is a separate drug insurance plan, not a supplement plan for Medicare Parts A and B. Medicare Part A is for hospitalization, Part B is for doctor visits, labs, surgery, etc., and Part D is for prescription drugs. You can buy a supplement plan to cover your coinsurance for Parts A and B, but I don't think you can buy a supplement plan for Part D.

[Pugchief]

The Plan I signed up for is a PPO, not an HMO. Big difference

Yes, it is a big difference. Maybe I misunderstood; didn't you say you had a Medicare Advantage plan? And if so, aren't those essentially HMOs?

Hallmarks of HMOs are:
limited network of providers, zero benefits out-of-network, and "gate keeping" by PCP. Please correct me if any of this is untrue.

[Pugchief]

I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist.

I agree 100% with this philosophy. Also, the provider network for Advantage plans are more limited.

[Dusty_Star]

I think you are referring to Medicare Part D, not Plan D. Part D is a separate drug insurance plan, not a supplement plan for Medicare Parts A and B. Medicare Part A is for hospitalization, Part B is for doctor visits, labs, surgery, etc., and Part D is for prescription drugs. You can buy a supplement plan to cover your coinsurance for Parts A and B, but I don't think you can buy a supplement plan for Part D.

Right, for regular Medicare you can buy a supplement also called Medigap policies, but you also buy a Plan D - drug plan. Plan D is the supplement for drug coverage, without which prescription drugs can be very expensive. Plan D type coverage for prescription drugs is often included in Advantage plans.

[biker1]

Part D, not Plan D, as previously posted.

Right, for regular Medicare you can buy a supplement also called Medigap policies, but you also buy a Plan D - drug plan. Plan D is the supplement for drug coverage, without which prescription drugs can be very expensive. Plan D type coverage for prescription drugs is often included in Advantage plans.

[MplsPete]

Just a moment... (https://you.com/search?q=do%20any%20medicare%20supplement%20plans% 20have%20a%20network&fromSearchBar=true&tbm=youchat&chatMode=default)

[golfing eagles]

I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist. .

I'll keep the answer short: Because the primary care doctor can diagnose and treat your sciatica just as well as an orthopedist, up to the point where you are in the 10% that need surgery.

[golfing eagles]

Yes, it is a big difference. Maybe I misunderstood; didn't you say you had a Medicare Advantage plan? And if so, aren't those essentially HMOs?

Hallmarks of HMOs are:
limited network of providers, zero benefits out-of-network, and "gate keeping" by PCP. Please correct me if any of this is untrue.

Some advantage plans are HMOs, some are PPOs.

[SusanStCatherine]

To answer your original question, I believe getting regular Medicare with a Medigap policy, you will have a much wider network than you currently have. Medicare is widely accepted. I currently have Florida Blue from the healthcare exchange and almost no decent providers accept it. I asked my providers if they accept Medicare and they all do. And some providers I am trying to get in to see say they take Medicare. Hope this helps.

[BrianL99]

I'll keep the answer short: Because the primary care doctor can diagnose and treat your sciatica just as well as an orthopedist, up to the point where you are in the 10% that need surgery.

I knew the day would come, when I'd agree with you.

Orthopedist seem to want to do nothing but operate. I had two guys tell me they wanted to operate on both my shoulders, for torn rotator cuffs. Gave me cortisone shots and told me to get ready for surgery.

One of my golfing buddies (a chiropractor, actually), said: Are you serious? At your age? After all that golf? It will be like trying to sew 2 pieces of wet toilet paper together. Go get 3rd opinion, bilateral rotary cuff failure doesn't happen over-night.

I know you won't approve of this part, but ... with the help of Google, my daughter & I diagnosed the real problem that my PCP had missed. PMR. Went to a Rheumatologist and 3 years later I'm cured (or dormant) and didn't lose a day of golf.

[BrianL99]

Just in case you didn't realize, all of the Supplemental Plans are identical in terms of coverage. In other words, one insurance company's Plan G is identical to another insurance company's Plan G. The cost, however, will vary. In addition, some of the insurance companies may allow you change from one plan to another (say move from Plan G to Plan N) without going through underwriting. For example, UHC in Florida allows this.

As I understand them, you're correct in all the plans are comparable. That said, not all plans are available in all states. Some states limit the Medicare Supplemental Plans that can be sold in their state.

In Massachusetts, there are only three plan types available: Core, Supplement 1 and Supplement 1A. There are other states (I believe) with similar standards.

To take it a step further, there are some regional agreements of some sort in place, for adjoining states. I had MA Medicare Supplemental and when I moved to NH, I was allowed to keep my MA Part A&B, but not Part D.

[golfing eagles]

I knew the day would come, when I'd agree with you.

Orthopedist seem to want to do nothing but operate. I had two guys tell me they wanted to operate on both my shoulders, for torn rotator cuffs. Gave me cortisone shots and told me to get ready for surgery.

One of my golfing buddies (a chiropractor, actually), said: Are you serious? At your age? After all that golf? It will be like trying to sew 2 pieces of wet toilet paper together. Go get 3rd opinion, bilateral rotary cuff failure doesn't happen over-night.

I know you won't approve of this part, but ... with the help of Google, my daughter & I diagnosed the real problem that my PCP had missed. PMR. Went to a Rheumatologist and 3 years later I'm cured (or dormant) and didn't lose a day of golf.

Your PCP missed a diagnosis of PMR? Ouch. Usually pretty obvious, and when your ESR comes back 130, it's even more obvious. Low dose/alt day steroids for you????

[SusanStCatherine]

Do an internet search and you will find that doctors and hospitals are currently dropping Advantage plans. All hospitals take Medicare - every single one. If you have been on your Advantage plan for awhile (I think it's a year) you need to be medically underwritten to get regular Medicare/Medigap unless your policy is in CT, ME, MA, or NY. If you have a Medicare/Medigap policy you can jump to an Advantage plan with no questions asked. You just won't be able to get back.

[BrianL99]

Your PCP missed a diagnosis of PMR? Ouch. Usually pretty obvious, and when your ESR comes back 130, it's even more obvious. Low dose/alt day steroids for you????

ESR over 130. 1 year of almost debilitating pain. Had PCP do CRP (after our Google research). CRP was 100+..

20 mg of Prednisone every day, taper when the CRP# and pain reduces. Up down, up down, up down for 3 years. Tapered all the way down to 2mg/day (3 times) ... then had to go back up again.

At least I didn't get balloon face and tolerated the Prednisone well. My CRP still runs around 15 or so, but I guess that's just me. "Treat the patient, not the numbers" my Rheumatologist says they taught her in school.

[golfing eagles]

ESR over 130. 1 year of almost debilitating pain. Had PCP do CRP (after our Google research). CRP was 100+..

20 mg of Prednisone every day, taper when the CRP# and pain reduces. Up down, up down, up down for 3 years. Tapered all the way down to 2mg/day (3 times) ... then had to go back up again.

At least I didn't get balloon face and tolerated the Prednisone well. My CRP still runs around 15 or so, but I guess that's just me. "Treat the patient, not the numbers" my Rheumatologist says they taught her in school.

Sorry you've had such a rough time of it---clearly you're in the worst 10% of PMR I've seen. The good news is that low dose and alternate day steroids are generally well tolerated, even for a long time. You will continue to have dosage adjustments, it's not an exact science. Hope you continue to get well.

[Pugchief]

To answer your original question, I believe getting regular Medicare with a Medigap policy, you will have a much wider network than you currently have. Medicare is widely accepted. I currently have Florida Blue from the healthcare exchange and almost no decent providers accept it. I asked my providers if they accept Medicare and they all do. And some providers I am trying to get in to see say they take Medicare. Hope this helps.

Weird. I have Blue Cross PPO from UpNorth thru the exchange and there are copious choices of in-network doctors down here.

[BrianL99]

Sorry you've had such a rough time of it---clearly you're in the worst 10% of PMR I've seen. The good news is that low dose and alternate day steroids are generally well tolerated, even for a long time. You will continue to have dosage adjustments, it's not an exact science. Hope you continue to get well.

Knock on wood, but I haven't touched Prednisone for about a year now. CRP stays around 15, but I feel great for 71. Now if I could just get my handicap back to where it was.

[OrangeBlossomBaby]

To answer your original question, I believe getting regular Medicare with a Medigap policy, you will have a much wider network than you currently have. Medicare is widely accepted. I currently have Florida Blue from the healthcare exchange and almost no decent providers accept it. I asked my providers if they accept Medicare and they all do. And some providers I am trying to get in to see say they take Medicare. Hope this helps.

Maybe almost no decent providers accept -your- plan. But FloridaBlue PPO marketplace (Bronze, Silver, Gold) plans have a nationwide network and MOST providers accept MOST FloridaBlue PPO plans. The HMOs are extremely limited.

Using the FloridaBlue provider directory /without/ logging in with my user name, I had no problem finding a dermatologist in Connecticut that accepts FloridaBlue insurance. Why? Because FloridaBlue is just Florida's Blue Cross Blue Shield affiliate.

But as I said - an HMO will be limited only to an exclusive list of providers and specialists, even if it's a national insurance company like BCBS. If you have a PPO, you'll have no trouble finding a doctor, group, specialist, hospital, that accepts FB. However, because of shortages of physicians, they might not be accepting new patients. But if they accept new patients, chances are they'll accept your insurance.

[Sabella]

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

I will refrain from adding all my comments about Medicare advantage plans, and the only thing that I know for sure is as you get older, and as we get older, we get sicker and more problems with our health you will wish you had stuck with original Medicare with a gap plan.

[SusanStCatherine]

Weird. I have Blue Cross PPO from UpNorth thru the exchange and there are copious choices of in-network doctors down here.

Well that is not the same plan if it is not Florida Blue. Is Advanced Dermatology in your plan? They dropped Florida Blue right before I had an appointment there. Also Jerrold Ecklind no longer takes it. My daughter got in as a new patient in 2021 to see him and I cannot get in until I get Medicare.

Florida Blue Select Bronze ppo/EPO -
A 64 y.o. Female non- smoker monthly premium $923/mo gets you a $6,150 deductible and a $9,450 out of pocket limit. So you get to pay (add premiums and deductible combined) $20,526 before they pay out the first penny. It's pretty much the least expensive PPO plan. Yet I've been told "Select" narrows the network further.
Florida Blue asked me if I want their medigap plan and I told them I hated my current plan so no way I would go with them so they hung up on me LOL

[SusanStCatherine]

My broker told me that I probably cannot switch between Medigap plans (like switching from plan N to plan G) not even within the same Insurer. So basically you are stuck with the plan you pick your first year for the rest of your life. The one exception is leaving medigap to join an Advantage plan at any time. So when you reach Medicare you are thrown back into the preexisting conditions that the ACA was meant to protect. SMH

[biker1]

Maybe. AARP UHC for Sumter County (and probably other counties in Florida or all of Florida) allows you to switch Supplemental Plans without underwriting. Perhaps this has changed in the last year but it was true about 1 year ago as my wife switched from Plan F to Plan G. Our broker, who has been reliable to date, told us she would warn us if UHC was going to change their policy regarding switching Plans without needing to go through underwriting.

My broker told me that I probably cannot switch between Medigap plans (like switching from plan N to plan G) not even within the same Insurer. So basically you are stuck with the plan you pick your first year for the rest of your life. The one exception is leaving medigap to join an Advantage plan at any time. So when you reach Medicare you are thrown back into the preexisting conditions that the ACA was meant to protect. SMH

[rustyp]

I have been enrolled in TVHS for over ten years. I never waited more than 5 minutes in a waiting room for my PCP or lab appointment. Today I escorted my spousal unit for labs at Qwest. We had a pre-booked online appointment. Still had to sit in a waiting room for an hour. To add to our not so satisfying experience there was a guy talking to his grand daughter on a cell phone the entire time which inhibited us from hearing the lab tech announcing the next person. He wasn't the only low life in that waiting room. Also there was literally a video notice on the wall if anyone is rude or obnoxious to other patients they will be asked to leave. I'll stick with TVHS where the facility looks like an upscale hotel and runs like a fine tuned watch.

Question - what do you folks with Medicare and a supplement do for labs ? Was our Qwest experience today abnormal ?