[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]

Originally Posted by LoriAnn

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]

Originally Posted by 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.

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]

Originally Posted by VillagesFlorida

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]

Originally Posted by downeaster

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]

Originally Posted by 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.

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!