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!

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.

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........

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.

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.

Yet more “facts not in evidence”

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.

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.

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.

I seem to be whistling in the wind, however...
 

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!!

Oh I wish we could talk and have a plan, seriously.
 

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!

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.