Which Medicare Advantage Plan?

[wendyquat]

We were able to attend two of the Medicare Part C Advantage Plans for 2012 today. One, United through AARP, is a PPO with no monthly premium but you still pay the entire Part B premium. The second, Preferred Care Partners, is a HMO with no monthly premium and they refund up to $75 per month of your Part B premium. The HMO plan offers very little co-pays but also confines you to staying in the network and your provider choices are somewhat limited. The PPO has some reasonable co-pays but the provider choices are more generous. I will have to do some more research but am leaning toward the PPO through AARP as we have had a Medicare Supplement (F) for a number of years and have been more than happy with the amounts paid and especially the service we have received.

If anyone currently has the Medicare Complete Plan through AARP I would love to have your input on how it has worked (or not worked) for you.

[LoriAnn]

The sole purpose of all Medicare replacement plans is to save Medicare money. That is accomplished by decreasing benefits to the Patient. They advertise services not offered by traditional Medicare to lure you. They never disclose all the benefit cuts compared to traditional Medicare. Keep in mind that everyone you are meeting with are sales people who stand to make money when you give up your traditional Medicare. Often they do not know every detail of the replacement policy in comparison to traditional Medicare. It is very complex. You always get more services with traditional Medicare. I have seen people choose replacement policies for gym memberships and covered medications that are generic inexpensive and generations removed. They never cover the most effective latest developed meds. In return the patient gets co-pays and/or deductables on hospitalizations, homecare, DME, and limited choices in providers. When a person on replacement policy needs a referral to a specialist they don't even get the best choices. The referral person can only pick from the list that accept that policy. Every provider accepts traditional Medicare, it's always the best choice.

[Avista]

We were able to attend two of the Medicare Part C Advantage Plans for 2012 today. One, United through AARP, is a PPO with no monthly premium but you still pay the entire Part B premium. The second, Preferred Care Partners, is a HMO with no monthly premium and they refund up to $75 per month of your Part B premium. The HMO plan offers very little co-pays but also confines you to staying in the network and your provider choices are somewhat limited. The PPO has some reasonable co-pays but the provider choices are more generous. I will have to do some more research but am leaning toward the PPO through AARP as we have had a Medicare Supplement (F) for a number of years and have been more than happy with the amounts paid and especially the service we have received.

If anyone currently has the Medicare Complete Plan through AARP I would love to have your input on how it has worked (or not worked) for you.

We attended informational sessions for both plans also and are leaning toward Preferred Care Partners. It seemed to include so much more.

Primary doctors PCP zero and specialists $10
AARP primary docs $10 and specialists $40

Hospital Days 1-5 PCP. $50/ day
AARP. $320/ day

Urgent Care PCP zero
AARP. $30

Plus PCP give back $75/ month

Would consider AARP, but now am leaning toward Preferred Care Partners.

This year I have been on Original Medicare, but expect to save over $3000 baring needing a lot of medical care. Even then out of pocket max is $5000.

[GTTPF]

All of this confuses me. I am on medicare part A and B and I have AARP as my suplemental and I don't pay any co pays. My agent set it up that way. Maybe he put me in a more expensive plan? I have a different company for prescriptions. :confused:

[LoriAnn]

You said it perfectly Avista, the replacement policies are great and save you money if you don't get sick. They are designed to save the Medicare system money in a Patients sickest years. Timing is everything. If a critical illness or injury occurs close to the window that allows you to change back to traditional Medicare, you win. Otherwise, a patient can have thousands of dollars in co-pays and deductibles. The maximum out of pocket is deceiving too. The replacements still pay all vendors much less than traditional Medicare. That puts a very sick patient in the position of not having access to the best providers. I have seen people spend their life savings for treatments not covered by their replacement. GTTPF, you have a supplement not a replacement. It sounds like you have kept your traditional Medicare and are paying for a supplemental policy. That is a safe choice.

[aljetmet]

My wife is on medicare disability and is on the AARP plan in Memphis. Plan pays much better in Memphis lower cost for hospital stay than TV ( well if you stay less than 5 days) and $3450 for max out of pocket for medical compared to $4500 in TV. Her medicine is on the plan. Most other plans do not have both drugs she takes. So you need to check the plan for your drug. She's had a brain MRI and other prodedures this year (her 1st) and the total out of pocket for medical has been only around $500. Much lower than I expected.
Medicare just pays very low and you pay 20% of the medicare amount.
Finding docs are a challenge but would bet it would be easier in TV.
We're having BCBS come to the house Monday. We'll see what they have to say...

[Avista]

You said it perfectly Avista, the replacement policies are great and save you money if you don't get sick. They are designed to save the Medicare system money in a Patients sickest years. Timing is everything. If a critical illness or injury occurs close to the window that allows you to change back to traditional Medicare, you win. Otherwise, a patient can have thousands of dollars in co-pays and deductibles. The maximum out of pocket is deceiving too. The replacements still pay all vendors much less than traditional Medicare. That puts a very sick patient in the position of not having access to the best providers. I have seen people spend their life savings for treatments not covered by their replacement. GTTPF, you have a supplement not a replacement. It sounds like you have kept your traditional Medicare and are paying for a supplemental policy. That is a safe choice.

Yes, traditional Medicare with a supplement and RX drug coverage is certainly a safe choice. It is what I nave been on. However it is quite expensive for many of us on fixed incomes.

With Preferred Care Partners I could save $3416/ year. Double that and include my husband and it comes to a savings of $6832/ year. We plan to put that money aside should we ever need it.

Here's how I get my figures:
2011 Medicare Supplement per month $160
2011 RX Plan. $48
Then add the $75 returned to you my Preferred Care Partners
Multiply by 12

With Preferred Care Partners I will have a Board Certified Internist.

If you need a cardiologist, here are the Cardiologists they use:

www.citruscardiology.org. They look good to me and are in Sumter Landing

This is a great thread and I would enjoy other comments. I haven't signed up yet, but am close to it.:BigApplause:

[2BNTV]

We were able to attend two of the Medicare Part C Advantage Plans for 2012 today. One, United through AARP, is a PPO with no monthly premium but you still pay the entire Part B premium. The second, Preferred Care Partners, is a HMO with no monthly premium and they refund up to $75 per month of your Part B premium. The HMO plan offers very little co-pays but also confines you to staying in the network and your provider choices are somewhat limited. The PPO has some reasonable co-pays but the provider choices are more generous. I will have to do some more research but am leaning toward the PPO through AARP as we have had a Medicare Supplement (F) for a number of years and have been more than happy with the amounts paid and especially the service we have received.

If anyone currently has the Medicare Complete Plan through AARP I would love to have your input on how it has worked (or not worked) for you.

I am in CT but Medicare Complete tells me I can sign-up in FL when I get there.

I have been on the Medicare Complete program for the last two years. It has worked well for me as I haven't had a need for hospitalization and the plan covers a lot of routine procedures.

My understanding is this program is designed more for preventive maintenance issues as opposed to someone who needs to regularly see a physician for known and ongoing problems. They receive your payment from ones SS check for the part B, (payment varies for each individual, mine is $110/mo), and includes a drug prescription program. All the providers in this program were doctors that I was seeing before starting with this program.

Medicare Complete is one choice amongst many plans available and the other is traditional Medicare with part D and a supplemental program if one chooses to go that route.

So far, I have been in good health in not requiring hospitalization. The one thing that bothers me has to pay for the first five days of hospital stay and the out of pocket max seems to increase yearly. Everyone has to decide if the program they are joining suits their medical needs and will give you piece of mind. Every year is the option to change plans and must be reviewed.

I'm sure another poster can tell you where in TV that services are offered to people to obtain information about plans that might best suit your needs as I don't remember where and who it is.

I hope this helps.

[StarbuckSammy]

Excellent thread and very informative. We have some very sharp members.

[downeaster]

All of this confuses me. I am on medicare part A and B and I have AARP as my suplemental and I don't pay any co pays. My agent set it up that way. Maybe he put me in a more expensive plan? I have a different company for prescriptions. :confused:

It appears you are not on a Medicare Advantage plan but on traditional Medicare with a supplement which is what I have and there is no way ads and meetings are going to lure me into an advantage plan. Too many pitfalls for my liking..

LoriAnn's posts above (#2 and #8) say it best.

[Carla B]

I agree with LoriAnn and Downeaster. Insurance companies determining which providers to see equal rationed care, to my way of thinking. I like the idea that with a Medigap plan as opposed to an Advantage plan, I can choose any doctor that takes Medicare and that the supplemental plan will cover the balance.

[ajdeck]

I am in CT but Medicare Complete tells me I can sign-up in FL when I get there.

I have been on the Medicare Complete program for the last two years. It has worked well for me as I haven't had a need for hospitalization and the plan covers a lot of routine procedures.

My understanding is this program is designed more for preventive maintenance issues as opposed to someone who needs to regularly see a physician for known and ongoing problems. They receive your payment from ones SS check for the part B, (payment varies for each individual, mine is $110/mo), and includes a drug prescription program. All the providers in this program were doctors that I was seeing before starting with this program.

Medicare Complete is one choice amongst many plans available and the other is traditional Medicare with part D and a supplemental program if one chooses to go that route.

So far, I have been in good health in not requiring hospitalization. The one thing that bothers me has to pay for the first five days of hospital stay and the out of pocket max seems to increase yearly. Everyone has to decide if the program they are joining suits their medical needs and will give you piece of mind. Every year is the option to change plans and must be reviewed.

I'm sure another poster can tell you where in TV that services are offered to people to obtain information about plans that might best suit your needs as I don't remember where and who it is.

I hope this helps.


The one thing that has kept us from moving to TV is the health insurance. I have cancer and have no idea of which is the best plan. After talking to a few people seems everyone is just as confused as I am.

Would be nice if one had one place to really get the whole story so you could make a real educated decison.
aj

[wendyquat]

Common sense tells me that Medicare with a AARP supplement and Part D (which is what we have) is the best situation but with the increases in premiums every year, I wonder how long it will remain affordable. Just looking at what the best option might be should we have to change to a less favorable plan.

Thanks for all the input.

[EdV]

The sole purpose of all Medicare replacement plans is to save Medicare money. That is accomplished by decreasing benefits to the Patient. They advertise services not offered by traditional Medicare to lure you. They never disclose all the benefit cuts compared to traditional Medicare. Keep in mind that everyone you are meeting with are sales people who stand to make money when you give up your traditional Medicare. Often they do not know every detail of the replacement policy in comparison to traditional Medicare. It is very complex. You always get more services with traditional Medicare. I have seen people choose replacement policies for gym memberships and covered medications that are generic inexpensive and generations removed. They never cover the most effective latest developed meds. In return the patient gets co-pays and/or deductables on hospitalizations, homecare, DME, and limited choices in providers. When a person on replacement policy needs a referral to a specialist they don't even get the best choices. The referral person can only pick from the list that accept that policy. Every provider accepts traditional Medicare, it's always the best choice.

While what you are saying here is true for Medicare Health Plans that are categorized as HMOs, it is not true for all Plans. Some plans like the AARP Choice plan mentioned are categorized as a PPO which allows you to use an out of network provider for an additional fee.

The best place to compare the various plans is right at the Medicare Website (http://www.medicare.gov/default.aspx)under the “Compare Drug and Health Care” menu option. Just follow the step by step guide and enter any medications you take. Be sure to select the option to save the medications list and jot down the serial number and password date that it provides you. After selecting the last step, it will give you a detailed list of each plan and an estimate of the annual out of pocket expense that you can expect to pay. You can even get adjusted figures if you have certain high cost ailments.

As for compensation to the insurance agent, they have a link to download a spreadsheet and view the agent's compensation for all the plans.

[LoriAnn]

PPO is generally a better option than HMO and PFFS. However they still have co-pay also known as co-insurance and deductibles that are not found in Traditional Medicare. All replacements including PPO, PFFS and HMO were specifically designed to spend less on services to the Patient. That is their sole purpose.

[aljetmet]

It really depends on your actual needs especially if you have a pre-existing condition.

My wife is taking a blood pressure medicine that is just not approved by lots of plans available in our locale. She's tried several other meds but they just don't work. She's on the AARP HMO Advantage plan (and the med she needs is approved) and her most important specialist is on the plan. She sees 5 different specialists and they are all fine with her and she is a little bit picky...

Last month when she was in NY waiting for #1 grandson to be born, she had her monthly injection in NY. AARP made it easy and she didn't pay a thing. (yet, I think I'll check that right now) adios!

[EdV]

PPO is generally a better option than HMO and PFFS. However they still have co-pay also known as co-insurance and deductibles that are not found in Traditional Medicare. All replacements including PPO, PFFS and HMO were specifically designed to spend less on services to the Patient. That is their sole purpose.

Where did you get that idea? These plans are simply Insurance Policies which are designed to limit your financial burden that a serious illness would cause. And like insurance on your home or car, there are various levels of deductibles. The higher the deductable, the lower the premium

Last year, I had to go to the emergency room. I was there for about 4 hours under observation and had an X-ray, scan, and blood tests. The total cost for that short stay was over 7,000 most of which was covered by my plan.

When I enter my meds into the Medicare comparison website program, it reports the following for my estimated annual out of pocket expenses:

Standard Medicare: 6,400
Standard Medicare with a Prescription Drug Plan: 4,000
AARP Choice Plan 2 (PPO): 3,300
Preferred Car Partners Gold (HMO): 1,200

So it really depends on each individuals health and medication needs as well as their tolerance for risk. No one size fits all.

[LoriAnn]

do you really think these plans were developed for your best interest? I work with these plans every day. You have been lucky enough to not require a service "yet" that will cost you dearly. Just wait........

[EdV]

I’m sorry but your statement “assumes facts not in evidence”. If you are the expert you purport to be, then you will not have any trouble producing facts and examples to back up your claims and warnings. And I’m not saying there aren’t any bad plans out there.

The retail cost of my meds is in excess of 3,200 per year and they're all in the plans that I looked at and it brings my out of pocket meds down to 600. I’m going to need a little more evidence than “trust me I know these things” before I go with plain vanilla Medicare which has no annual cap on out of pocket expenses and costs at least twice as much.

So what would you choose in my case and why. I'm all ears.

[LoriAnn]

As you stated, you've done your research. Live with it a little while. Some lessons you have to learn on your own. Your rolling the dice anytime you opt out of traditional Medicare. If you don't have a serious illness such as a heart attack or a stroke and require long hospitalization, rehab, homehealth, DME you may come out with a savings. Another example of a policy that works great until you get sick.

[EdV]

Yet more “facts not in evidence”

[aljetmet]

As you stated, you've done your research. Live with it a little while. Some lessons you have to learn on your own. Your rolling the dice anytime you opt out of traditional Medicare. If you don't have a serious illness such as a heart attack or a stroke and require long hospitalization, rehab, homehealth, DME you may come out with a savings. Another example of a policy that works great until you get sick.

I'm not sure what you mean you are taking a risk by opting out of traditional medicare. Do you mean that you may not have choice of Dr or health facility when opting out? Do you mean not to get any supplemental plan at all? Every plan tries to reduce your financial burden albeit you just cannot go anywhere you want. You get sick without a medigap or advantage plan you are in deep trouble. That's what I call rolling the dice.

I personally have 25% of our retirement budget dedicated to health. If we don't spend it all the extra funds will go in a special account to build when the rainy day comes.

[Avista]

I'm not sure what you mean you are taking a risk by opting out of traditional medicare. Do you mean that you may not have choice of Dr or health facility when opting out? Do you mean not to get any supplemental plan at all? Every plan tries to reduce your financial burden albeit you just cannot go anywhere you want. You get sick without a medigap or advantage plan you are in deep trouble. That's what I call rolling the dice.

I personally have 25% of our retirement budget dedicated to health. If we don't spend it all the extra funds will go in a special account to build when the rainy day comes.
That is exactly what we are doing. If we don't have a serious illness, we will be over $6000 ahead each year. This will go into a special account for, like you said for that rainy day. Actually, Preferred Care Partners, has a $5000 out of pocket limit in case of a worse scenario.

[VillagesFlorida]

As you stated, you've done your research. Live with it a little while. Some lessons you have to learn on your own. Your rolling the dice anytime you opt out of traditional Medicare. If you don't have a serious illness such as a heart attack or a stroke and require long hospitalization, rehab, homehealth, DME you may come out with a savings. Another example of a policy that works great until you get sick.

I HAVE done some research and here is what I found regarding some of the scenarios you pointed out. The figures I am presenting here are for Original Medicare with no supplemental insurance, and the advantage plan I have, which is Preferred Care Partners Gold Plan

A "long hospitalization" (I'm using the time limits on the Medicare website and the Preferred Care partners 2012 coverage booklet) of 150 days:

If all I have is Medicare I would pay out-of-pocket $43,582

PCP..........I would pay $350 co-pay, total, for the first 7 days only. No limit on additional days.

Rehab in skilled nursing facility:

Medicare: $0 for days 1-20
$ 141.50 per day, for days 21-100
Total for 100 days=$11,320 out-of-pocket

PCP: $0 for days 1-10
$ 50 a day, for days 11-20
$ 75 a day, for days 21-100
Total for 100 days $6500 out-of-pocket

Home Health Care coverages are the same and the costs are the same, $0.

Medicare pays 80% for out-patient rehab
PCP has a $25 co-pay

Hubby has required Durable Medical Equipment for 15 years for his sleep apnea. When we had Medicare and a supplemental policy that we paid extra for our cost was $0. On PCP our cost is $0.

Now, if one wants to buy a supplemental policy that will pick up the 20% that Medicare doesn't cover that is an extra cost every month. When we left AARP United Health Care supplemental coverage last year we were paying $200 a month ea. for medical and drug coverage. PCP includes drug coverage at no cost and it is every bit as good as what I was paying almost $40 a month for. PCP will be returning $75 to me in 2012, every month, for the Medicare Part B premium. If I stay reasonably healthy I will have an extra $3300 a year in my savings account. (Yes, we tuck away the savings we are realizing every month). If, worst case scenario I have a serious illness, I have a $5000 out-of-pocket maximum.

As for not being able to go to any doctor I want, or not receiving good medical care in the future should I need "specialists", etc., there are many good and qualified doctors on the PCP provider list. As far as I am concerned the care I have received from the PCP doctors has been as good, and maybe even better as what I got when I was paying the big bucks.

We could all go on debating this issue for years, and we probably will. In the end, we have to educate ourselves and then make the best decision we can about our health care coverage.

[wendyquat]

It's very interesting to read all the opinions and that's what I wanted. BUT I did not anticipate any reponses that one would NOT have Medicare plus some kind of supplemental policy. That would really be leaving yourself open to big out of pocket expenses. This day and time having to pay the 20% not covered by Medicare could bankrupt one very quickly.

[Doodlegirl]

maintain Medicare without an additional plan, BUT go if necessary to a not for profit hospital in Florida. You cannot be followed by a large bill. If the
Villages hospital was not for profit, you would find substantially better care
(in my opinion) since they would be 'writing off' overwhelming cost to you...and to them. I love TV, I've been here since July, I am shocked at the status of Medicare issues here, the vitals reports on physicians, and about ready to give Mr. Morse a call and have a long talk. With 80,000 some seniors here, this 'city' could use a collaboration with a large not for profit hospital and doctor's who are part of that type of system. Try and find a
qualified gerontologist. This is an area in which we must all be proactive.
We worked, we paid into Social Security and the Medicare 'benefit' most all of our lives. It is time to clarify both our Medicare 'rights' and the extra
fee's here. I really have a plan, it keeps me up at night I swear, and I'm going to try and pull it off with a major not for profit medical center. Seriously concerned. I'm a doctor, but not that kind! However, I understand how the process is supposed to work for those of us who paid our dues!

[wendyquat]

maintain Medicare without an additional plan, BUT go if necessary to a not for profit hospital in Florida. You cannot be followed by a large bill. If the
Villages hospital was not for profit, you would find substantially better care
(in my opinion) since they would be 'writing off' overwhelming cost to you...and to them. I love TV, I've been here since July, I am shocked at the status of Medicare issues here, the vitals reports on physicians, and about ready to give Mr. Morse a call and have a long talk. With 80,000 some seniors here, this 'city' could use a collaboration with a large not for profit hospital and doctor's who are part of that type of system. Try and find a
qualified gerontologist. This is an area in which we must all be proactive.
We worked, we paid into Social Security and the Medicare 'benefit' most all of our lives. It is time to clarify both our Medicare 'rights' and the extra
fee's here. I really have a plan, it keeps me up at night I swear, and I'm going to try and pull it off with a major not for profit medical center. Seriously concerned. I'm a doctor, but not that kind! However, I understand how the process is supposed to work for those of us who paid our dues!

I SO agree with you about the lack of choice in doctors! In some other areas of the country, doctors have quit accepting Medicare patients due to red tape and amounts paid by Medicare! With that in mind, you might not get the get the best doctors in an area that is made up primarily of Medicare recipients! I'm hoping I'll find a doctor that is not in it "just for the money" but so far have not been impressed.

As to your comment about seeking a "not for profit" hospital, that is not always a luxury you can expect to have. I assume if you are in an accident or have a stroke, heart attack or a number of other emergencies you're taken to the nearest hospital without much choice in the matter! Also, it seems to me that most treatments are not even done in a hospital any more. I can't imagine paying 20% out of pocket for things such as cancer treatments. I have had many friends treated for breast cancer and it is not unusual for one treatment to be in excess of $5,000 and this can go on for months and months. If one can't afford a Medicare supplement, it seems to me that an advantage plan would be better than nothing.

Let me know what Mr. Morse says!!

[Doodlegirl]

I worked for a major not for profit medical center for nearly 20 something years in an administrative capacity. While not an MD, I certainly was at all of the meetings with the docs and with other Admin. I get it from that perspective. And as a TV'er now I am scared to death about what might
happen if I should become ill. Just finding a doctor to accept Medicare here was a real trial, totally amazed me. That appointment next week.

A perfect example, I think, is my late Mom. She was in a for profit hospital on the coast of east mid coast FL in congestive heart failute and with a poor prognosis. I spoke with her doctor, had her transported to my physician and into a not for profit hospital in Ft. Lauderdale by ambulance, and she not only survived, but thrived, within hours AND with a corrected diagnosis. The cost was relatively small for the ambulance to drive some 200 miles and to reach a hospital with every piece of equipment and physicians qualified to treat her
were available. Mom lived on 15 more years and her Medicare coverage was accepted in whole.

I'm not saying docs and hospitals don't deserve to make $, but not on the backs of the elderly I don't think. Believe me, on Monday morning I am making the first of several calls. Maybe futile, but we are a City here, and
we deserve to have not only the friendliest place to live, but the ability to
get the best medical and hospital care available. Not for profit hospital's, as you know, simply put the majority of their earnings back into the hospital's operational budget...and their foundations and giving aspects assit them in this effort. Can you believe it was the ONLY qualifier I didn't examine when I moved here, silly me thinking it would, of course, all be in place. Wrong.
I'm not afraid of calling Mr. Morse, I am more afraid to hear, historically, how all of this came to be. Perhaps, he will rethink the issues his constituency face. Better if he was 62 or 65! I'll give it a try...and I know just the Med
Center that might be interested, too! :) A world reknowned facility. Hip, hip hooray. C'mon down and help me!

[VillagesFlorida]

I SO agree with you about the lack of choice in doctors! In some other areas of the country, doctors have quit accepting Medicare patients due to red tape and amounts paid by Medicare! With that in mind, you might not get the get the best doctors in an area that is made up primarily of Medicare recipients! I'm hoping I'll find a doctor that is not in it "just for the money" but so far have not been impressed.

As to your comment about seeking a "not for profit" hospital, that is not always a luxury you can expect to have. I assume if you are in an accident or have a stroke, heart attack or a number of other emergencies you're taken to the nearest hospital without much choice in the matter! Also, it seems to me that most treatments are not even done in a hospital any more. I can't imagine paying 20% out of pocket for things such as cancer treatments. I have had many friends treated for breast cancer and it is not unusual for one treatment to be in excess of $5,000 and this can go on for months and months. If one can't afford a Medicare supplement, it seems to me that an advantage plan would be better than nothing.

Let me know what Mr. Morse says!!

Regarding the possibility of having to pay 20% out of pocket for breast cancer treatment, yes, that would be a lot of money. I think that most people who have Medicare DO have some sort of supplemental insurance that would likely cover the 20%. I am a breast cancer survivor of 10 years and I know that I COULD face this sort of treatment in the future if my cancer returns. However, I also know that my out-of-pocket total cost will be no more than $5000 per year. If you take into consideration that I am saving $3300 a year by being on an advantage plan my net cost would go down to $1700. I absolutely agree that an advantage plan would be the way to go if one can't afford a supplement to Medicare. Medicare without a supplement is like paying 20% of much of one's health care costs.

[wendyquat]

Regarding the possibility of having to pay 20% out of pocket for breast cancer treatment, yes, that would be a lot of money. I think that most people who have Medicare DO have some sort of supplemental insurance that would likely cover the 20%. I am a breast cancer survivor of 10 years and I know that I COULD face this sort of treatment in the future if my cancer returns. However, I also know that my out-of-pocket total cost will be no more than $5000 per year. If you take into consideration that I am saving $3300 a year by being on an advantage plan my net cost would go down to $1700. I absolutely agree that an advantage plan would be the way to go if one can't afford a supplement to Medicare. Medicare without a supplement is like paying 20% of much of one's health care costs.

Good point for the Medicare advantage plan and a good enough reason to check and make sure the doctors that you might want treating breast cancer to be either in the HMO or PPO. I think my biggest fear is needing a particular specialist and being told "it's not in your network". Of course, if they are in the network on January 1, 2012 it does not guarantee they'll be in that network when you actually need them.

Just for the record, when checking my prescriptions with the AARP Medicare Complete formulary, 3 of mine are tier 3 while they are currently tier 2 on my Part D. Haven't checked them on PCP formulary yet.

[LoriAnn]

The likelihood of attracting a larger well equipped not-for-profit hospital to the area has a lot to do with the prevalence of replacement policies. Traditional Medicare pays much higher than a replacement. Every provider of services which includes hospital, MD's, testing centers, labs, home health, DME must make a decision on being out-of-network or in-network with each replacement plan. Out-of-network means 25-30% copay along with deductibles. If they choose to be in network they must sign a contract agreeing to accept payments that are much lower than traditional Medicare. To complicate matters, the replacements pay very, very slow. That is why most providers accept traditional Medicare and the replacements have spottier available providers. If a provider such a specialist is in great demand, they are much less willing to accept poor paying insurances. My guess is that traditional Medicare with supplements are in the majority if only by a nose because of Moffitts willingness to open cancer treatment center here.

[2BNTV]

The one thing that has kept us from moving to TV is the health insurance.

The major reason I didn't move when I first saw TV is that I wouldn't have health coverage and a very good friend who was the picture of health had developed a serious heart problem that required surgery. Shortly thereafter, the housing market crashed and burned.

I have cancer and have no idea of which is the best plan. After talking to a few people seems everyone is just as confused as I am. aj

I am so sorry to hear of your having cancer and I can fully understand why you are staying put so you can receive the care you would need. I started to look at the literature last night and had to put it down before my head exploded. So confusing and very unclear in their terminology.

Would be nice if one had one place to really get the whole story so you could make a real educated decison.

AMEN to that statement.

It would be helpful if all plans would generate a "Benefits at a Glance" booklet instead of a thick manuel that is a chore in itself to understand. I will call my plan today and find out how much the plan changed from last year.

So many options to choose from and everyone has to decide for themselves what plan best suits their needs.

Best wishes on your health ajdeck.

[VillagesFlorida]

I am so sorry to hear of your having cancer and I can fully understand why you are staying put so you can receive the care you would need. I started to look at the literature last night and had to put it down before my head exploded. So confusing and very unclear in their terminology.

Would be nice if one had one place to really get the whole story so you could make a real educated decison.

AMEN to that statement.

It would be helpful if all plans would generate a "Benefits at a Glance" booklet instead of a thick manuel that is a chore in itself to understand. I will call my plan today and find out how much the plan changed from last year.

So many options to choose from and everyone has to decide for themselves what plan best suits their needs.

Best wishes on your health ajdeck.

In the back of the new Medicare booklet for 2012 there are brief comparisons of the "Medicare Health Plans" available in our area. Check those out, narrow your choices down to a few, and examine those in detail by going to their web sites or ordering paper material that you can peruse at your leisure. Compare coverage and costs to original Medicare and don't forget to add in the expense of a good supplement if going with Medicare.

[chachacha]

The benefits from Preferred Care Partners and Freedom etc are tempting but i am sticking with my PPO because if something serious happens, i want to be able to go to Shands in Gainesville which is considered our best hospital, and even though it is out of my network, at least part of my bill would be paid, whereas i don't think ANYTHING would be covered under an HMO which is out of network. Am i correct about this or am i misguided?

[2BNTV]

In the back of the new Medicare booklet for 2012 there are brief comparisons of the "Medicare Health Plans" available in our area. Check those out, narrow your choices down to a few, and examine those in detail by going to their web sites or ordering paper material that you can peruse at your leisure. Compare coverage and costs to original Medicare and don't forget to add in the expense of a good supplement if going with Medicare.

Thanks for the hints. I saw a plan that might suit my needs better at less cost. The old plan was increasing cost for the same coverage as last year. I called the newer plan and asked for literature. Same doctors I go to now with lower deductibles. :)

I love this site as it has so many knowledgable and wonderful members. :)

Thanks again.

[EdV]

I HAVE done some research and here is what I found regarding some of the scenarios you pointed out. The figures I am presenting here are for Original Medicare with no supplemental insurance, and the advantage plan I have, which is Preferred Care Partners Gold Plan

A "long hospitalization" (I'm using the time limits on the Medicare website and the Preferred Care partners 2012 coverage booklet) of 150 days:

If all I have is Medicare I would pay out-of-pocket $43,582

PCP..........I would pay $350 co-pay, total, for the first 7 days only. No limit on additional days.

Rehab in skilled nursing facility:

Medicare: $0 for days 1-20
$ 141.50 per day, for days 21-100
Total for 100 days=$11,320 out-of-pocket

PCP: $0 for days 1-10
$ 50 a day, for days 11-20
$ 75 a day, for days 21-100
Total for 100 days $6500 out-of-pocket

Home Health Care coverages are the same and the costs are the same, $0.

Medicare pays 80% for out-patient rehab
PCP has a $25 co-pay

Hubby has required Durable Medical Equipment for 15 years for his sleep apnea. When we had Medicare and a supplemental policy that we paid extra for our cost was $0. On PCP our cost is $0.

Now, if one wants to buy a supplemental policy that will pick up the 20% that Medicare doesn't cover that is an extra cost every month. When we left AARP United Health Care supplemental coverage last year we were paying $200 a month ea. for medical and drug coverage. PCP includes drug coverage at no cost and it is every bit as good as what I was paying almost $40 a month for. PCP will be returning $75 to me in 2012, every month, for the Medicare Part B premium. If I stay reasonably healthy I will have an extra $3300 a year in my savings account. (Yes, we tuck away the savings we are realizing every month). If, worst case scenario I have a serious illness, I have a $5000 out-of-pocket maximum.

As for not being able to go to any doctor I want, or not receiving good medical care in the future should I need "specialists", etc., there are many good and qualified doctors on the PCP provider list. As far as I am concerned the care I have received from the PCP doctors has been as good, and maybe even better as what I got when I was paying the big bucks.

We could all go on debating this issue for years, and we probably will. In the end, we have to educate ourselves and then make the best decision we can about our health care coverage.

Excellent post VillagesFlorida, this is an example of “Facts In Evidence”. Unless someone can find an error in the math it should be able to stand on its own. It doesn’t mean it’s the final answer, but it sure beats the “Trust me I know posts”.

[B&BTexas]

Do you have any Primary Care Physician recommendations for the Prefered Care Partners Gold Plan? We will be using this plan when we move around the first of 2012. We are both healthy and only have one prescription between us. For us this plan makes the most sense given our health, at least the first year.
B&BTexas

[LoriAnn]

Excellent post VillagesFlorida, this is an example of “Facts In Evidence”. Unless someone can find an error in the math it should be able to stand on its own. It doesn’t mean it’s the final answer, but it sure beats the “Trust me I know posts”.

I don't think anyone ever implied that traditional Medicare alone is the best option. The ideal protection includes a supplement or secondary insurance. I understand that everyone cannot afford that option. In that case, you do the best you can. I never said "trust me I know". But, unfortunately I do. I am a managing partner of a physician-owned hospital that has a home health, hospice, free standing therapy, and rehab component. Learn from what I know, or ignore it. It's your choice. If I thought you really wanted to understand (EdVinMass) I would be more specific ,but, I suspect you prefer to argue and insult. I'm moving to another thread to talk about tempur-pedic beds or something a bit less prone to anger.

[EdV]

. If I thought you really wanted to understand (EdVinMass) I would be more specific ,but, I suspect you prefer to argue and insult. I'm moving to another thread to talk about tempur-pedic beds or something a bit less prone to anger....

I'm not angry, where did that come across? I'm just trying to debate the issue, and it's a very important one, don't you thinK?

[Avista]

Do you have any Primary Care Physician recommendations for the Prefered Care Partners Gold Plan? We will be using this plan when we move around the first of 2012. We are both healthy and only have one prescription between us. For us this plan makes the most sense given our health, at least the first year.
B&BTexas

My husband is pleased with Janmejay Shaktawat (Dr Jay). I am in the process of transferring to him. He is a board certified Internist. Did his residency in PA. Website is:
www.tcp,group.com

He is on Wedgewood Dr and also in Spanish Springs.

I'm sure there are other good docs as well.

[English Ivy]

For everyone posting about Preferred Care Partners Gold Plan for 2012, are you aware that it is not the same Gold plan as for 2011?

In 2011 the Gold plan was the "better" plan with more coverage but no reimbursement of $'s. In 2012 the "better" plan will, I believe, be referred to as the "Select" plan.

It's very confusing!

[Avista]

For everyone posting about Preferred Care Partners Gold Plan for 2012, are you aware that it is not the same Gold plan as for 2011?

In 2011 the Gold plan was the "better" plan with more coverage but no reimbursement of $'s. In 2012 the "better" plan will, I believe, be referred to as the "Select" plan.

It's very confusing!

Yes, there a some minor changes. They merged the 2 2011 plans into one. This year we will receive $75 back, and $25 quarterly for
OTC medication. Also, we will need a referral for some specialists. Specialists are $10 copay. Primary care docs do not have a copay. Hospital days are $50 for first 5 days then zero.

[drdodge]

You should go to a Freedom Health seminar. I have been with them for 3years and I have a good relationship with them. I do not pay anything for their plan. Last year they took care of about 70.000 in charges. It does not cost anything to listen
drd

[VillagesFlorida]

You should go to a Freedom Health seminar. I have been with them for 3years and I have a good relationship with them. I do not pay anything for their plan. Last year they took care of about 70.000 in charges. It does not cost anything to listen
drd

I was thinking of doing that, just to compare to PCP's plan. You are correct, it doesn't cost a thing to sit there and take notes! Information is power! My main concern would be the list of providers and how that compares to the Preferred care Partners list. I am going to go online to see what information I can find there. I should be able to see a provider list there.

[Avista]

You should go to a Freedom Health seminar. I have been with them for 3years and I have a good relationship with them. I do not pay anything for their plan. Last year they took care of about 70.000 in charges. It does not cost anything to listen
drd

We looked into Freedom. One of the differences I see is that their first five hospital days are $225 each, whereas Preferred Care Partners is $50/day. Their specialists have a $30 copay and Preferred Care $10.

Also, our physicians are not on Freedom.

This is a great discussion. I keep looking to see if I can find anything better, but so far I like Preferred Care Partners.

[downeaster]

I talked to a Medicare Advantage provider today. I explained my medical problem for which I am being treated at USF Health in Tampa. They couldn't tell me in advance if that treatment would be covered . After joining the plan I would have to have USF Health submit documentation to them and they would then decide if it were covered. I can't take that gamble so I will stick with my current conventional Medicare with supplemental coverage. It has served me well for many years.

My point in sharing this is to point out potential pitfalls in Medicare Advantage plans. I was able to make an obvious decision based on my current condition. Had I not already had the condition and switched providers and was later diagnosed with that condition and if it did not qualify I would be looking at tens of thousands of dollars of out of pocket expenses.

Insurance, by definition, is to provide financial coverage for the unexpected.

[EdV]

I don't think anyone ever implied that traditional Medicare alone is the best option.....

Well in Post #18 you made the following statement “Every provider accepts traditional Medicare, it's always the best choice” so what else are we expected to understand you meant.

[VillagesFlorida]

I talked to a Medicare Advantage provider today. I explained my medical problem for which I am being treated at USF Health in Tampa. They couldn't tell me in advance if that treatment would be covered . After joining the plan I would have to have USF Health submit documentation to them and they would then decide if it were covered. I can't take that gamble so I will stick with my current conventional Medicare with supplemental coverage. It has served me well for many years.

My point in sharing this is to point out potential pitfalls in Medicare Advantage plans. I was able to make an obvious decision based on my current condition. Had I not already had the condition and switched providers and was later diagnosed with that condition and if it did not qualify I would be looking at tens of thousands of dollars of out of pocket expenses.

Insurance, by definition, is to provide financial coverage for the unexpected.

I understand your concern and you are probably doing the right thing by staying with your current insurance. Keep in mind, though, that the advantage plans have yearly out-of-pocket limits. Preferred Care's Select plan has a $3400 a year limit, the Gold plan $5000 for 2012. As I said in an earlier post my savings over Medicare with a supplement will be $3300 a year. It would take me an awfully long time to get to the "tens of thousands of out of pocket expenses" that you talked about above.

[Avista]

Just came home from a meeting with Mirta at Preferred Care at the Ittle Red Schoolhouse in Sumter Landing. Now I am all signed up for 2012 Perferred Care Partners.

[downeaster]

I understand your concern and you are probably doing the right thing by staying with your current insurance. Keep in mind, though, that the advantage plans have yearly out-of-pocket limits. Preferred Care's Select plan has a $3400 a year limit, the Gold plan $5000 for 2012. As I said in an earlier post my savings over Medicare with a supplement will be $3300 a year. It would take me an awfully long time to get to the "tens of thousands of out of pocket expenses" that you talked about above.

My point was the possibility of pitfalls. If you read the ad on page ten of today's Sun you will note they state there are situations where you may not be covered by either Medicare nor Medicare Advantage.

[VillagesFlorida]

My point was the possibility of pitfalls. If you read the ad on page ten of today's Sun you will note they state there are situations where you may not be covered by either Medicare nor Medicare Advantage.

Yes, I did read the ad that Preferred Care Partners has in today's Sun....I think what it is saying is that if I go out of network they will not pay unless I have a POS plan. Since PCP has a contract with Medicare, Medicare will not pay either. I DO know from experience that "urgent care" is covered out of network, since I had to avail myself of this service this summer when I was in New England. Also, should I need to go to a hospital when I am out of the area I will be covered. That out of network hospital will have to get authorization and I would have to return to a network hospital as soon as my condition had stabilized enough. So, I have confidence that I will receive proper medical care no matter where I am in the United States. Being happy in one of these advantage plans depends mostly on how willing one is to play by the rules. Avista is a good example of someone who has educated herself about all of these plans. She made a choice today based on her research and in talking directly to the PCP representative. She knows the ins and outs as to how an advantage plan works. I sense from her post that she is very happy tonight with her decision.

[Floridagal]

I met with an AARP MedicareComplete Choice Plan 2 agent today. I have an AARP supplement and a separate drug plan. I have these plans 4 years and my husband and I have been very happy. We do not like HMO's so we have not looked into Preferred Care or Freedom Care. After going over everything with this agent, whom I think did an excellent job in explaining everything, even telling us right up front that we have one of the best plans, we did some serious talking and decided to go with the Advantage Plan as we both are pretty healthy and we will be saving a little under $5200 a year total for both our payments and drugs for the year. He did explain that if were not happy with this plan we can opt out anytime during the first year and go back to what we had but at a slightly higher cost and go into a drug plan. With that in mind we will be signing up for the new plan. Unless we really get sick (and I pray we wouldn't) I don't even think we will meet the annual out of pocket maximum of $5,900 each for the year. All our drugs are in the plan, either Tier 1 or 2 and all our doctors but two and I don't feel finding a new one will be a problem. My main concern was that my primary doctor be on the list and he was on their list, and I think he is the best and have been using him almost 7 years. One other doctor that my husband thinks is wonderful is also on the list.

But the bottom line is, you go with what you feel comfortable with.

[Avista]

We also met with a rep of AARP Complete Choice. I like that one had the freedom to go out of network. This plan may be one I would consider in future years.

The negatives for me were:
Co Pays on tier one meds
Co Pay primary docs
Specialist copay $40

Copay 5 days in hosp stay $975. Not as good as preferred care partners at $250, but better than many
Max out of pocket $5900 vs $5000 preferred care partners.

Let me know if made an error in these figures. I'm using my husbands spread sheet.

My husband did a spread sheet on all these plans LOL

I do like this one as it lets one go out of network although pay more for this.

If Preferred Care Partners does not work for me this year, I would consider this next year.

[EdV]

For 2012, I believe the first 5 days of AARP in-network hospital stay co-pay will be $320/day or $1600.

[Skip2MySue]

A little more fuel for the mind being the Consumer Report magazine rated healthcare plans for each state this month. Both HMO and PPO plans and the providers.
Skip 2

[Avista]

There was a good article in today's (10-19-11) Sun, Section C right side about Preferred Care Partners

[Floridagal]

If you are interested in an HMO then it is a good deal.

[wendyquat]

Lots of good thoughts on both HMO's and PPO's. I can see everyone is doing their homework. I am type II diabetic. These advantage plans only guarantee they'll be with your for one year at a time. My biggest fear is even if I am happy with the advantage plan of choice for next year, what will happen if I am forced to go back to a regular medicare supplement and Part D for drugs? I know when you first go on Medicare at 65 they can't deny or uprate you for pre-existing conditions but I do believe if you try to get it back at a later date that they CAN. I'd have to be assured that this would not happen. As far as HMO or PPO, my current doctors are in the PPO network but not the HMO. That would be enough to sway me toward the PPO. Good luck to all of you on your choices and thanks for your input.

[villagerjack]

I had a Medicare Advantage and it was a nightmare even finding out what I was covered for and the doctors and hospitals I was allowed to use. Even their web sites are confusing. Finally I got out and have been back on traditional Medicare. I have no problems getting doctors or hospitals now. BTW they really fought me about changing back. It took over a week of constant phone calls even though I was in the period I was permitted to make changes.

[VillagesFlorida]

I had a Medicare Advantage and it was a nightmare even finding out what I was covered for and the doctors and hospitals I was allowed to use. Even their web sites are confusing. Finally I got out and have been back on traditional Medicare. I have no problems getting doctors or hospitals now. BTW they really fought me about changing back. It took over a week of constant phone calls even though I was in the period I was permitted to make changes.

Some of the information CAN be difficult to understand. I have had no problems with Preferred Care Partners. Their booklets are easy to understand. Providers are listed by county so I check the counties in this area to see what my choices are. Early on I had aquestion about coverage so I called the customer service office. They were very helpful and I got the information I needed. All of this can be very confusing and it takes time to read all of the information they send out every year. I don't mind taking the time to figure it out, considering what I am saving in premiums!

[RayB]

One of the big advantages of Preferred Care is the fact they have a office right here at Sumter Landing. One can stop in or call and get straight answers right away. There is no being put on hold or talking to someone who is not speaking English very well or does not understand your particular problem. This office knows their local providers which is most helpful. I went on Preferred Care last year and my wife is going on it for 2012. We are saving $3300 each in savings over Medicare part B premiums, AARP supplemental insurance premium, and Wellcare Part D Pharm. insurance premiums. Included in the savings is a $75 return from our Medicare Part B premium. I reviewed seven other advantage programs and found Preferred provided the least out of pocket expenses potential for us. We will be putting the $6600 savings for us away in a separate account to pay for any out of pocket expenses we will have in 2012 to cover the potential $5000 potential maximum out of pocket expenses will MIGHT have with the Preferred Gold plan. At worst case situation we will still be ahead. At best we will have saved a combined savings of $6600. Not bad.

[wendyquat]

I still haven't seen anyone comment as a person with a pre-existing condition and their experience with a Medicare Advantage plan and what might happen if they have to go back to traditional medicare and supplement. Since the Medicare Advantage plans are working for them, it hasn't been an issue. I just wonder what the future will be for Medicare Part C plans and what might happen if "Obamacare" makes them not feasible. I agree that if all is going well with you and your Part C plan (HMO or PPO) right now you might not think of what will happen if you have a pre-existing condition and are forced to go back on traditional Medicare and seek a supplement. Please chime in if you have had an experience with this.

[Avista]

I still haven't seen anyone comment as a person with a pre-existing condition and their experience with a Medicare Advantage plan and what might happen if they have to go back to traditional medicare and supplement. Since the Medicare Advantage plans are working for them, it hasn't been an issue. I just wonder what the future will be for Medicare Part C plans and what might happen if "Obamacare" makes them not feasible. I agree that if all is going well with you and your Part C plan (HMO or PPO) right now you might not think of what will happen if you have a pre-existing condition and are forced to go back on traditional Medicare and seek a supplement. Please chime in if you have had an experience with this.

I suppose it depends on the pre-exiting condition. It would be important to check the specialist providers on any particular advantage plan. It would also be important to have a primary care provider in which you have confidence. I too have some pre-existing conditions. I have researched in the specialists I may have to use at some point. If I find Preferred Care Partners does not work for me, next year I will look at PPOs that allow one to go out of network.

[VillagesFlorida]

I still haven't seen anyone comment as a person with a pre-existing condition and their experience with a Medicare Advantage plan and what might happen if they have to go back to traditional medicare and supplement. Since the Medicare Advantage plans are working for them, it hasn't been an issue. I just wonder what the future will be for Medicare Part C plans and what might happen if "Obamacare" makes them not feasible. I agree that if all is going well with you and your Part C plan (HMO or PPO) right now you might not think of what will happen if you have a pre-existing condition and are forced to go back on traditional Medicare and seek a supplement. Please chime in if you have had an experience with this.

I have seen an oncologist every few months for follow-up after breast cancer surgery and treatment, 10 years ago. I left Medicare and a supplemental insurance policy almost a year ago to go with the Preferred Care Partners Advantage Plan (It will become the "Gold Plan" starting in January). I don't know why I would be "forced to go back on traditional Medicare and seek a supplement"? The only way I can see that happening is if advantage plans are discontinued for some reason. I believe that all of us thousands, who would be faced with going back to traditional Medicare, would do so without being penalized for pre-existing conditions. If I CHOOSE to go back on traditional Medicare, just because I don't want to be with an advantage plan anymore, there is no doubt that I would be denied or slapped with super high premiums by the supplemental insurance company. Since I believe that keeping my life as stress-free as possible is what I need to do as a cancer survivor, I do not spend any time worrying about "what might happen". I trust that everything will work out fine. As for my experience with an advantage plan as a cancer survivor, I am receiving great care and I have a terrific oncologist who is compassionate and thorough. Some of the oncologists I saw while on Medicare left a lot to be desired. I hope this helps.

[Gretch298]

How about pre-existing conditions? We need to find one that will cover my husbands chemo. Any ideas on that? What might be best in that case? Thanks....

[VillagesFlorida]

How about pre-existing conditions? We need to find one that will cover my husbands chemo. Any ideas on that? What might be best in that case? Thanks....

I assume that you are asking about an advantage plan covering chemo? Preferred Care Partners plans cover chemo drugs at 80%. As far as I can tell I would be responsible for the 20% co-pay. There IS an out-of-pocket maximum that I would have to pay, yearly, of $3400 or $5000, depending on which policy I was with. (They offer two in this area) Factoring in the partial return of my Medicare Part B premium ($75 per mo.) and my savings from what I used to pay for a supplemental policy, plus drug coverage ($200 per mo.) I am saving $3300 per year. This means that the most actual out-of-pocket expenses I would have would be $100 or $1700, depending on the plan I have. As to pre-existing conditions, PCP never asked me about my health issues as far as cancer is concerned. If your husband has Medicare and a supplemental policy, and you do NOT want to worry about paying 20% of his chemo drugs, perhaps you and he might have more peace of mind if you stay with that coverage. With ANY advantage plan that you look at be sure to note what your total out-of-pocket expenses will be for a year.

[Avista]

Good News. Preferred Care Partners will cover a Curves membership for me. Visited them today in Sumter Landing and set up an orientation appointment early Jan.

[LarryL]

Very helpful thread. One thing I noticed is that people say the Advantage Programs "save medicare money". That is not true. Medicare advantage programs are paid a bonus of approximately 12% over the cost of medicare. That is something the Affordable Care Act is trying to reduce. The advantage plans make money by reducing their risk AND getting more from the Governement.

[joyce beaty]

This response is not considered a recommendation of either supplemental or advantage plans. However, I want to inform you of an issue that I became aware of this year. I just turned 65, and was also anxiety ridden over choices. During my research I discovered the first year of Medicare (your 65th year) you are in a period by which you may change plans during the year for any reason; therefore, you are not required to wait until open enrollment. One agent was unaware of this and verified its validity(Florida Blue). Of course, this is only applicable your first year of Medicare. I realize this may not apply to many of you, but those who are not 65 yet should be aware of this.
For that reason, and the fact that I am in good health, I chose an advantage plan. However, if 'trouble' begins this first year, I will change immediately to a supplemental. Again, this choice is only available your first year. At the close of my first year, I will make decision of continuing my advantage plan. Just a few more mind-boggling words about this very complex decision.

[champion6]

Very helpful thread. <snip>.Caution, LarryL. The posts you were reading are about 2 years old!

[ijusluvit]

I still haven't seen anyone comment as a person with a pre-existing condition and their experience with a Medicare Advantage plan and what might happen if they have to go back to traditional medicare and supplement. Since the Medicare Advantage plans are working for them, it hasn't been an issue. I just wonder what the future will be for Medicare Part C plans and what might happen if "Obamacare" makes them not feasible. I agree that if all is going well with you and your Part C plan (HMO or PPO) right now you might not think of what will happen if you have a pre-existing condition and are forced to go back on traditional Medicare and seek a supplement. Please chime in if you have had an experience with this.

I had just signed up for a Medicare Advantage plan last year when I was diagnosed with pancreatic cancer. So during 2013 I have been forced to pay the 20% coinsurance costs of Part B chemo drugs, etc, up to the out-of pocket ceiling of $5000. I am choosing to change my policy to the AARP UHC Plan F for next year, since the total annual premium costs are about $2300. Obviously that is better than paying $5000 for an Advantage plan. One of the benefits of the Affordable Care Act is that you can get any Advantage plan regardless of pre-existing conditions. However, you cannot get a Medigap or supplemental plan at the low advertised prices with pre-existing conditions unless you are a resident of several states. Those include New York and Connecticut. My NY residency gives me the full range of choices. The only time folks with pre-existing conditions from other states, including Florida, can get guaranteed admission to a Medigap plan is in the first six months after their 65th birthday, their first six months of Medicare registration.

[jazzeoneaj]

I had just signed up for a Medicare Advantage plan last year when I was diagnosed with pancreatic cancer. So during 2013 I have been forced to pay the 20% coinsurance costs of Part B chemo drugs, etc, up to the out-of pocket ceiling of $5000. I am choosing to change my policy to the AARP UHC Plan F for next year, since the total annual premium costs are about $2300. Obviously that is better than paying $5000 for an Advantage plan. One of the benefits of the Affordable Care Act is that you can get any Advantage plan regardless of pre-existing conditions. However, you cannot get a Medigap or supplemental plan at the low advertised prices with pre-existing conditions unless you are a resident of several states. Those include New York and Connecticut. My NY residency gives me the full range of choices. The only time folks with pre-existing conditions from other states, including Florida, can get guaranteed admission to a Medigap plan is in the first six months after their 65th birthday, their first six months of Medicare registration.

[COLOR="Blue"]The information you gave was wonderful and first I hope you are doing well and are comfortable with the choices you have with medical treatment.

I know a few people with AARP Plan F..you are correct..it is a good one.
What I don't know is what is the monthly premium on this..if there is one? Do you feel it gives you more leaway to 'choice'.

Thank you and God Bless!!

[SusanOfWoodbury]

I am confused with all the medicare plans available. 2013 I have Perfered Partners, but, in 2014 they are not available. So I am looking at HMO United Healthcare or HMO Freedom Health

Does anyone have any information that will help me to decide which way I should proceed?

[wendyquat]

I am confused with all the medicare plans available. 2013 I have Perfered Partners, but, in 2014 they are not available. So I am looking at HMO United Healthcare or HMO Freedom Health

Does anyone have any information that will help me to decide which way I should proceed?

We have had UHC plan F since joining Medicare a few years ago. Being open enrollment we were once again considering UHC Advantage plan but I called our Cardiologists, which we like very much and depend on, and were told that they were being dropped for the HMO as of 2014 so we won't be changing anything! I suggest you check with your doctors as to what plans they will be participating in.

[wendyquat]

I had just signed up for a Medicare Advantage plan last year when I was diagnosed with pancreatic cancer. So during 2013 I have been forced to pay the 20% coinsurance costs of Part B chemo drugs, etc, up to the out-of pocket ceiling of $5000. I am choosing to change my policy to the AARP UHC Plan F for next year, since the total annual premium costs are about $2300. Obviously that is better than paying $5000 for an Advantage plan. One of the benefits of the Affordable Care Act is that you can get any Advantage plan regardless of pre-existing conditions. However, you cannot get a Medigap or supplemental plan at the low advertised prices with pre-existing conditions unless you are a resident of several states. Those include New York and Connecticut. My NY residency gives me the full range of choices. The only time folks with pre-existing conditions from other states, including Florida, can get guaranteed admission to a Medigap plan is in the first six months after their 65th birthday, their first six months of Medicare registration.

Thank you! Just the info I was looking for. Good luck to you!

[gomoho]

I had just signed up for a Medicare Advantage plan last year when I was diagnosed with pancreatic cancer. So during 2013 I have been forced to pay the 20% coinsurance costs of Part B chemo drugs, etc, up to the out-of pocket ceiling of $5000. I am choosing to change my policy to the AARP UHC Plan F for next year, since the total annual premium costs are about $2300. Obviously that is better than paying $5000 for an Advantage plan. One of the benefits of the Affordable Care Act is that you can get any Advantage plan regardless of pre-existing conditions. However, you cannot get a Medigap or supplemental plan at the low advertised prices with pre-existing conditions unless you are a resident of several states. Those include New York and Connecticut. My NY residency gives me the full range of choices. The only time folks with pre-existing conditions from other states, including Florida, can get guaranteed admission to a Medigap plan is in the first six months after their 65th birthday, their first six months of Medicare registration.

I believe there is one other exception where you can get into a supplement plan without underwriting (no questions asked) and that is when your plan is terminated i.e. this year with Preferred Care Partners. So if you are a PCP member currently check with an agent and I believe during the Special Enrollment Period you will be allowed to sign up for a supplement.

[cinepuxon]

I strongly advise anyone thinking of dropping a Medigap Plan (ie, supplement) and switching to a Medicare Advantage plan to get free unbiased advice from trained counselors from the SHINE program. They offer counseling sessions at the various Villages Rec Centers now through Dec 7. MA plans are attractive because of no premiums but your choice of doctors and specialists may be limited and your out-of-pocket (OOP) can be $6000/$10000 in/out of network. If you are healthy they are great but getting seriously ill is another thing. With a Medigap supplement you may never see a co-pay for anything (depending on the plan). Something to consider as one ages. Please see a SHINE counselor before you make any binding decisions. 1-800-96-ELDER or 1-800-963-5337 for more info.

[ijusluvit]

[COLOR="Blue"]The information you gave was wonderful and first I hope you are doing well and are comfortable with the choices you have with medical treatment.

I know a few people with AARP Plan F..you are correct..it is a good one.
What I don't know is what is the monthly premium on this..if there is one? Do you feel it gives you more leaway to 'choice'.

Thank you and God Bless!!

Thank you too! The AARP Plan F is $177. monthly in New York. It varies state-to-state and it is somewhat higher in Florida. I have been told that there will be absolutely no restrictions on my treatment choices either in NY or here at the Moffatt Center.

[llaran]

I processed claims for 20 years, and I will never recommend an HMO. Think about coverage. ..do you want to go to the very best Dr for your condition? Anywhere in the country? You can with traditional Medicare. Ask about copays do they apply to the OOP? Most do not. Remember insurance buys you peace of mind, you pay auto and home coverage and may never use it but if you need it,it is there.