Talk of The Villages Florida

Talk of The Villages Florida (https://www.talkofthevillages.com/forums/)
-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   Which Medicare Advantage Plan? (https://www.talkofthevillages.com/forums/medical-health-discussion-94/medicare-advantage-plan-43703/)

RayB 10-22-2011 10:10 AM

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 10-22-2011 07:42 PM

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 10-22-2011 07:55 PM

Quote:

Originally Posted by wendyquat (Post 409237)
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 10-22-2011 08:19 PM

Quote:

Originally Posted by wendyquat (Post 409237)
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 10-22-2011 10:35 PM

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 10-23-2011 08:00 AM

Quote:

Originally Posted by Gretch298 (Post 409284)
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 11-17-2011 08:20 PM

Preferred Care Partners
 
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 11-02-2013 09:20 AM

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 11-02-2013 10:17 AM

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 11-02-2013 10:55 AM

Quote:

Originally Posted by LarryL (Post 772767)
Very helpful thread. <snip>.

Caution, LarryL. The posts you were reading are about 2 years old!

ijusluvit 11-02-2013 10:57 AM

Quote:

Originally Posted by wendyquat (Post 409237)
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 11-02-2013 12:30 PM

Quote:

Originally Posted by ijusluvit (Post 772849)
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 11-02-2013 09:55 PM

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 11-02-2013 10:27 PM

Quote:

Originally Posted by SusanOfWoodbury (Post 773194)
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 11-02-2013 10:28 PM

Quote:

Originally Posted by ijusluvit (Post 772849)
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!


All times are GMT -5. The time now is 03:44 AM.

Powered by vBulletin® Version 3.8.11
Copyright ©2000 - 2025, vBulletin Solutions Inc.
Search Engine Optimisation provided by DragonByte SEO v2.0.32 (Pro) - vBulletin Mods & Addons Copyright © 2025 DragonByte Technologies Ltd.