[Dejola]

Myself and my wife are both covered by Medicare. In addition, as a retired New York State municipal employee we also have group health insurance provided by the so-called Empire Plan and administered by United Healthcare. This is partially subsidized by the town I was employed by before I retired. Even with the partial subsidy I pay $491.53 monthly in premiums.

Since Medicare is now our primary carrier and the Empire Plan is secondary it seems like I'm not getting the same "bang for my buck" that I got before we got on Medicare. This has caused me to look at alternatives to the Empire Plan.

TV ads are hawking all kinds of so-called medigap or supplementary insurance. Medicare Advantage plans are among those being advertised heavily. Such plans are being offered by all the insurance carriers, including United Healthcare, The Hartford, and on and on. AARP sponsors one of them. In fact United Healthcare, which administers The Empire Plan offers separate standalone (non-group) Medicare Advantage Plans. One may be called Medi-Blue, I believe.

I'm trying to decide if I should stay with the New York State Empire Plan or switch to one of the Medicare Advantage Plans, some of which require zero premiums (versus the $491.53 a month I'm now paying).

I understand there are some disadvantages to the Medicare Advantage Plans, including (but not necessarily limited to) the fact that with the Medicare Advantage Plans the carrier, not Medicare, becomes the primary carrier. You know longer deal with Medicare; the Medicare Advantage Plans require an HMO type coverage (with the Empire Plan I can go to whatever doctors I choose and do not need a referral); my doctors may not be in the HMO network; and finally, the so called prescription drug "donut" situation.

I'm wondering if there are any knowledgeable souls here who can advise me about these matters.

I sort of feel that while the New York State Empire Plan may be a very robust plan I may be paying too much for the fewer benefits we get since The Empire Plan is now our secondary health insurance carrier.

By switching to a zero premium Medicare Advantage Plan I could save almost $500 a month. But at what cost in coverage and benefits? That is the question.

All comments and advice will be appreciated.

Thanks.

[JenAjd]

We had some of the same concerns as you so we went down to the insurance office off the square and spoke with someone there. You'll need to call and make an app't but it will happen fairly quickly. It was most helpful as she plugged our info into the computer and came up with the best plan that fit our needs. It was better than winging it on our own and she can offer advice etc. None of the ads were helpful and of course they all make it sound like "theirs" is THE best. Go to a professional who can walk you through this.
Hope this helps!!!!

[elevatorman]

There is a group that helps explain the options to you. they don't sell Ins. but will help in choosing the best plan for you. Do a search for SHINE on this site.

[missyomama]

The people at SHINE are great. They will walk you through the whole process. Since they do not sell insurance they have no bias and point to the best deal for your individual situation. Good luck to you.

[JenAjd]

Clarification....the insurance company didn't have any investment into our decision and told us as much. As it turned out the best company for us to go with was one they weren't familiar with so she gave us the contact info and we came home and called on our own. We just needed direction as the "poster" here seems to be needing. I'm sure Shine(which we hadn't known about) is a good source as well. You will NOT have to pay for getting the information that you need.

[Dejola]

Many thanks to all who have responded to my inquiry. It looks like SHINE is just the kind of unbiased, no dog in the fight, kind of information we're looking for. We'll be pursuing this with SHINE.

Thanks again to all.

[2BNTV]

Dejola:

It is a good idea to check with SHINE. Below is a post that asked a smiliar question. I hope it helps you.

2BNTV
Senior Member Join Date: Mar 2010
Location: Connecticut
Posts: 324



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Quote:
Originally Posted by cybrgeezer
This is slightly off the subject, but since someone opened the Medicare bag, here goes:

I am just about to turn 65 (in November) and will lose my employer's insurance Jan. 1 due to hours reduction, so I am looking at various Medicare plans.

I am sure many of you have studied this and can give me an answer to this question -- if you considered a Medicare Advantage plan with little or no premium and an included Part D and decided to go with a regular supplement+D, how did you make that decision?

The advantage plan I'm looking at has a $0 premium and all my doctors plus several local hospitals accept it. What would convince me to go with a regular supplement plan?

Again, I am sure you (some of you, at least) have faced this and come to the decision best for you. I'd really like some input.

As for personal information that matters here, I am single and taking several medications, so a Part D (included or separate) is important. My overall health is good and I have not been an inpatient in a hospital since 1986. I am active in cycling and other activities and have used emergency rooms several times, the most recent 10 years ago. Any of this factor in?

Thanks for any help.

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Cybrgeezer,

As an independent agent who offers both the Medicare Supplements (AARP), and three of the Medicare Advantage companies, there is no right answer to your question of whether an Advantage plan with $0 premium is the best way to go, or whether there is a convincing argument to go with a Med Supp. It's a matter of your risk tolerance, and peace of mind. The lady who went with the AARP Med Supp wanted to be able to go to any doctor anywhere in the country without having to pay hospital or doctor copays-Peace of mind, no risk. If you stay relatively healthy you will save money with the Medicare Advantage plans. It is important that your doctors (and future Specialists) and The Villages Hospital be in their network (As well as Leesburg and Ocala Hospitals). There are now maximum out of pocket limits in all Medicare Advantage plans this year, so with a catastrophic health event the most you will have to pay out of pocket per year varies from $3500 to $6700 depending on the plan. Hope this helps a litte. If you would like anymore informaton please send me a private message.
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Cybergeezer;

The above is an excellent answer but one has to consider their family's history of health problems and try to gaze in their crystal ball to figure out for themselves what plan is best for them. If a person expects they will stay in excellent health for many years, the Medicare Complete Plan through AARP Secure Horizon's is a good choice. The Medicare Complete program is geared toward "preventive medicine" type situations. The OOP Expense Max for 2011 is $44oo and catastrophic coverage is $8800. It depends on one's resources whether they afford to absorb this loss if one does get sick.
Going forward, if one decides they will need frequent medical treatment for ailments, they will need the original Medicare plus part D and a Supplemental plan to cover almost all OOP cost. Supplemental Plans cost more in premiums but are geared more towards people who require seeing a doctor on a regular basis and needs to be hospitalized periodically and don't want to absorb these costs or want to have peace of mind for catastrophic coverage.
One can switch from year to year but as we get older, the premiums will be higher for the supplemental type plan.
A friend of mine had paid the supplemental for many years and bemoaned the fact that it was costing her a small fortune in premiums. She switched her and her husband to Medicare Complete to not pay the difference in premiums and shortly thereafter, her husband developed a severe problem that required going to many doctors and hospitals. She switched at the wrong time in her opinion.
IMHO – I am in excellent health and chose the Medicare Complete from AARP.
It is a PPO in CT and when I move to TV, I can stay in tha same type plan. IT allows me to see the doctors I want and I don't need a referral to see a specialists. There are many options and I know my head was spinning thinking of what plan was best for me. One has to take an educated guess and hope their decision will turn out to be correct for them.

There is no clear cut answer because one never knows their future health.

I wish you the best of luck with your choice.

[nitestars]

I am also in Empire and on Medicare. It is difficult to make a change as I am not sure where health care is headed for. I like having the PPO option and HMO's offered by zero-payment plans cpould end up being more expensive for OOP's as they limit many items. I have decied for now to stay with Empire (I only have coverage for myself at a monthly premium of $150 through my ex employer). I know many people who switched to zero payment plans but have limited coverage and several physicians will not accept some plans. I seem to hear that United has been oaky for many,but then again, it depends on our health needs. I sympathize with you in your dilemma we are all in a quandry now.