[shcisamax]

,,,,

[MSGirl]

What is the "advantage" to have an advantage plan over Plan F?

[rubicon]

I received an e-mail that explains what is affecting Florida blue Advantage and other plans.

The 10,535 pages of ACA condensed into four simple sentences:

"In order to insure the uninsured, we first must have to uninsure the insured.

Next, we require the newly uninsured to be reinsured.

To reinsure the newly uninsured requires extra charges to the reinsured.

The extra charges are required so that the original insureds who became uninsured and then became reinsured ,can pay enough extra so that the original uninsureds can be insured which will be free of charge

This is called redistribution of wealth or by its more common name SOCIALISM"

[Chi-Town]

Just think, if Congress were ever in town they could vote to repeal the ACA. [emoji6]

[dillywho]

Originally Posted by MSGirl

What is the "advantage" to have an advantage plan over Plan F?

We have advantage plans and they are not "free". The premium is paid monthly from our SS to the tune of $104.90 each. Just because you do not sit down and actually write a check or have a draft drawn does not make anything free when it is deducted from your check be it a SS check or a paycheck with a deduction for company insurance. There are co-pays for doctors, hospitals, ambulance, etc. Does not translate to "free", either. Even with the co-pays, it is still a better deal than traditional Medicare plus supplements, which continue to rise each year you are enrolled.

Now to the difference. I used to have traditional Medicare and a supplement plus a drug plan. The Medicare deduction was taken from my SS then, too. I also paid almost $200 a month for my supplement and almost $50 a month for Part D (mandated drug coverage). They do allow for balance billing in most instances (not allowed with our plans). That means that if everything is not allowed, you often get stuck for the extra. The Plan F only pays for the 20% that Medicare picked up the 80% on. If you are billed $120 and Medicare approves $100, then they pay $80 and Plan F pays $20. Sometimes, not always, you get to pay a portion of the other $20.

Now with the advantge plan, the drug coverage is included and the out-of-pocket expense caps at $10,000 if you use both in and out of network (drugs do not count toward this). Medicare has no cap and there is a big deductible everytime you are hospitalized, which in turn will drive up the cost of your supplement over time.

Mine is a PPO, not HMO. PPO you get to choose your doctors as long as they accept your plan and do not have to get a referral from your primary (I call those referral plans Mother-May-I plans).

My husband and I have advantage plans with the same company. Before that, he did not have a supplement to his traditional Medicare and guess who got to pick up the 20+ percent? Everytime he was hospitalized, there was a deductible of $1684.00 which is not a yearly deductible. It is an event deductible. He did not have to have a Part D plan because most of his meds came from the VA. If he could not get them from the VA (very few he couldn't, thank goodness), then it was full price unless the pharmacy offered a senior discount. With the advantage plan, the co-pay is so much per day for the first 5 days in the hospital. The Medicare deductible applied regardless of how many days, even just one.

Wordy, I know, but hope it helped to explain the differences.

[gatherer47]

I have the Freedom Advantage plan.Of course Soc.Sec.deducts the $104 every month for medicare.I pay $0 for the monthly premium.And of the $104 deducted for Social Security,under Freedom's Plan I get $72 of that back because of a preexisting diabetic condition.Freedom is starting seminars Oct.2 to explain the changes for 2015.

[gomoho]

Dillywho - that was an excellent explanation. What you didn't mention was the penalty that was probably imposed on your husband for each year he did not have an advantage or supplement plan. Don't know if the penalty was waived for his part D because of VA eligibility???

[RErmer]

AARP MedicareComplete Regional PPO is maintaining 0 premium for next year, though some copayments are going up. This excludes the $104.90 Part B premium. I know because my husband's book came today.

[JoMar]

Of course the only Advantage plan The Villages accepts is United Healthcare.

[dillywho]

Originally Posted by gomoho

Dillywho - that was an excellent explanation. What you didn't mention was the penalty that was probably imposed on your husband for each year he did not have an advantage or supplement plan. Don't know if the penalty was waived for his part D because of VA eligibility???

There is no penalty for not having an advantage or supplement plan (other than the fact that we got to pay the 20% that would have been paid by a supplement). The penalty comes in for drug coverage and yes, it is waived for those enrolled in the VA system since it qualifies as being equal to or better than Medicare Part D. I signed up as soon as it came into being so have had no penalty.

When he went back to work at his old job after retiring, he dropped his supplement thinking that he would be able to pick it back up when he retired again. I tried my best to convince him that it didn't work that way, but what did I know.....I am just a wife. His company insurance became his primary insurance and his Medicare his secondary. He kept telling me that he didn't want to pay premiums to both.

Lesson to anyone who has retired and goes back to work after getting on Medicare and purchases a supplement. Don't drop your supplement! You get one shot at it with no questions asked within so many days. After that, you have to prove insurability. Since he had suffered a debilatating stroke, he was not insurable at any price for a supplement.

It just really bothers me when people (especially the younger generations), say that seniors are getting a free ride. We paid all our working lives, as did our employers with matching funds on our behalf, and we are still paying! Participation was not and is not optional. When you have paid and are still paying, I would like for someone to explain to me what I am getting for "free". As for receiving more than we put in, that is true of any insurance regardless of the entity. When you file a claim against your insurance company, your benefits are always above what you pay in, and most of those you have not paid into for almost an entire lifetime.

Life insurance, car insurance, medical insurance, any insurance, is a highly sophisticated game of chance (gambling). They're betting you won't ever need to make a claim, and all the while you are paying premiums, and you are betting that at some point you will file.

We got our new benefits booklet today and our co-pays have gone up, but that is no surprise. Name me something that hasn't.

Hope this answered your questions that you asked me. If not, I'll be happy to try again.

[NYGUY]

Originally Posted by RErmer

AARP MedicareComplete Regional PPO is maintaining 0 premium for next year, though some copayments are going up. This excludes the $104.90 Part B premium. I know because my husband's book came today.

The same for me, the premium is still ZERO, and the primary doc copay goes from $10 to $15 with specialists staying the same....it works for me!!

[NYGUY]

Originally Posted by JoMar

Of course the only Advantage plan The Villages accepts is United Healthcare.

According to a recent Tampa Bay Times article, this was a major reason for the University of South Florida pulling their specialists out of The Villages Health system (not enough enrollees in United Healthcare's Advantage program).

[rubicon]

Of course the problem with all of this discussion is that increases to premiums are given as are the increase in co-pays co-insurance and the like because as a whole half of the participants will be fully financed by the government

[gomoho]

Dillywho - thank you for the correction - I was confusing the part B penalty. My apologies.

Just dawned on me that Medicare pretty much works like Obamacare - if you don't sign up you get penalized if and when you do choose coverage.