[coffeebean]

In January, I have to make a decision as to which medicare advantage plan to go with due to my husband's retirement and therefore I will transition to post medicare. My husband and I have been reading reviews for United Health Care and Humana. My head is ready to explode after reading the awful reviews of both of these plans.

I don't plan on using The Villages Health Care system as of now because the current Doctors that I see are not in their system. I just want to use this plan for my doctors that I have been going to since I have moved to The Villages.

The common "theme" of the reviews is that people verify with the insurance company that their provider is in network. Come time for the bill to be paid, both plans claim the providers were "out of network" and will not pay the claim.

What has your experience been with either United Health Care Medicare Advantage plan or Humana Medicare Advantage plan?

[rustyp]

Good luck - I would not be taking advice from here. My experiences is 180 degrees from what most have posted on here for this subject. Everybody's an expert but they don't want to give up their doctor or we are not switching insurance form our previous employer etc. Then there is the crowd that believes you have to go to some fancy high class institution to get good care including the cure for a hangnail. Find someone down here with similar background as you and your previous employer and area where you lived plus has a couple year head start on you. Be sure to ask when being sited chapter and verse if their experience truly happened to them or "I heard this from ". A good place to start is SHINE. As an aside I believe UHC is the largest health insurance company in the USA.

[Dan9871]

Originally Posted by coffeebean

What has your experience been with either United Health Care Medicare Advantage plan or Humana Medicare Advantage plan?

We have UHC Advantage and use Villages Health. This has worked out very well for us both for everyday health issues and for major health issues too. When we transitioned from regular Medicare to Advantage my wife had to change one of her specialist which was a bit of a worry, but in the end it worked out just fine.

The UHC Advantage plans come in two kinds. The ones that are zero cost only pay for in network providers. You can get exceptions for out of network providers (we did once, it was a phone call and a form, pretty easy) but there is no guarantee it will be approved. But in any case any Advantage plan has to provide all the services that regular Medicare does even if only an out of network provider is needed.

However there are other ones that will also pay for out of network providers but they are not zero cost and have higher copays and higher out-of pocket expense limits.

We've had the zero cost plan for the last 4 years and getting services and specialists haven't been a problem.

You have to check with the current doctor to see if he or she is in-network even if the UHC plan lists them in network, the list of doctors in the plan documents are not always correct. So you will have to ask your current doctors if will theyaccept any of the insurance plans you want to use.

You mention going to Medicare Advantage... if you instead go with regular Medicare you can go to any doctor that will accepts Medicare and will accept you as a patient. That might be the easiest way to stay with your current doctor.

[mtdjed]

I have seen the term Zero Cost being used regarding Medicare Advantage programs. I do not like this description since I have been paying toward Medicare since it began through payroll deductions.. Since I have retired and am on Social Security (which I also paid premiums all my working life), I also have a monthly premium for Part B Medicare deducted from my SS payment. For 2018 that premium was $134/Mo which is $1608 per year. Without going into details and recognizing that each persons data is unique, it is likely that I have at least $2000 invested into Medicare Part A and Part B benefits. Then if I select a "Zero Cost " Advantage program, I am really paying the $2000 for this program.

[Dan9871]

Originally Posted by mtdjed

I have seen the term Zero Cost being used regarding Medicare Advantage programs. .

Just to be clear the Zero Cost refers to the cost of a supplemental plan that covers the 20% and other things that Medicare doesn't cover, not to the cost of Medicare.

Some supplemental plans cost zero and some cost more that most people pay for Medicare part A and B.

[mtdjed]

Originally Posted by Dan9871

Just to be clear the Zero Cost refers to the cost of a supplemental plan that covers the 20% and other things that Medicare doesn't cover, not to the cost of Medicare.

Some supplemental plans cost zero and some cost more that most people pay for Medicare part A and B.

Not my understanding. It is my understanding that when you sign up for Advantage you no longer have Med Part B coverage from the government. Part A Probably. Supposedly, the Advantage program gets to cover the entire Part B.


This/ My understanding is why some one told the OP Good luck trying to get info here.

[villagetinker]

OP, contact SHINE for unbiased information, what works well for one person maybe a disaster for another. We had an Advantage plan for a while, had problems, found out we could go back (NOTE: this is not always the case), so we went back to Medicare and a supplemental.

SHINE - Home

Good luck with your quest.

[Dan9871]

Originally Posted by mtdjed

Not my understanding. It is my understanding that when you sign up for Advantage you no longer have Med Part B coverage from the government. Part A Probably. Supposedly, the Advantage program gets to cover the entire Part B.


This/ My understanding is why some one told the OP Good luck trying to get info here.

Yes, when you sign up for Advantage you no longer have coverage directly through either part A or part B. But the Advantage plan has to, by law, provide all the coverage you would have had with part A and part B. In general Advantage provide coverage beyond what part A and B do. However you still have to pay for part A and B if you have an Advantage plan and what is covered is the same as what would be covered if you had regular Medicare.

See the paragraphs at the beginning of each of these pages.

What Part B covers | Medicare

What Part A covers | Medicare

[coffeebean]

Originally Posted by villagetinker

OP, contact SHINE for unbiased information, what works well for one person maybe a disaster for another. We had an Advantage plan for a while, had problems, found out we could go back (NOTE: this is not always the case), so we went back to Medicare and a supplemental.

SHINE - Home

Good luck with your quest.

Hubby and I will be speaking to a SHINE representative this week at the Lake Miona Rec center. Thanks letting me know about SHINE in your previous post.

[coffeebean]

Thanks to all who have replied. My main concern about the Medicare Advantage plans is the awful reviews hubby and I have read about them. People claim they verified that providers are in network then the insurance companies insist those said providers are NOT in network. I don't know if I can trust the information I receive regarding who is in network and who is not in network.

Have any of you had problems with the providers not being in network after you were assured they were in network? I'm referring to any of the Medicare Advantage plans such as United Health Care, Humana and Aetna.

[rustyp]

Originally Posted by coffeebean

Thanks to all who have replied. My main concern about the Medicare Advantage plans is the awful reviews hubby and I have read about them. People claim they verified that providers are in network then the insurance companies insist those said providers are NOT in network. I don't know if I can trust the information I receive regarding who is in network and who is not in network.

Have any of you had problems with the providers not being in network after you were assured they were in network? I'm referring to any of the Medicare Advantage plans such as United Health Care, Humana and Aetna.

From a provider standpoint it does not matter which plan. Doctors come and go all the time out of any provider's plan throughout the plan year. Again UHC is the biggest health provider in the USA. Probably a correlation to the most in network Vs size - not sure. As far as your first post some statement that the ins co refuse to pay because of out of network - not likely. Most pay but cost you higher copays (or the difference) due to out of network. Now you need to compare out of pocket maximums to safeguard yourself against that situation. Go to the hospital and ask are you in network. Most likely yes. Now ask is everyone involved in my hospital care in network. You won't get a straight answer to that. I had an emergency visit to TV a few years ago. Hospital in network. Emergency room doctor out of network. Perhaps the emergency room doctor on the previous shift was in network. How are you going to control that ? Bottom line for me is I have TV UHC. The best and easiest insurance I've ever dealt with. The plan works very well here and in New York State when I do my snowbird thing. Love my doctors and specialists.

[Dan9871]

Originally Posted by coffeebean

Have any of you had problems with the providers not being in network after you were assured they were in network? I'm referring to any of the Medicare Advantage plans such as United Health Care, Humana and Aetna.

Yes, quite some time ago before we moved to the Villages we were in an Advantage plan and my wife's doctor sent her to a provider for a prothesis. About two months after the visit we got a bill for about $800 with a statement that coverage was denied because the provider was out of network. She called her doctor about it and in the end the company allowed the claim I guess because her doctor thought the provider was in-network. I forget which company it was.

Two years ago the same prothesis needed replacement and UHC Advantage wanted my wife to travel to a provider in Mt. Dora which is about an hour drive for us.

She found a provider nearby in the Villages that was not in network and would not accept UHC Advantage. She called UHC and told them she didn't want to go all the way to Mt. Dora when there was another provider right nearby... that is no medical need just convenience. UHC said ok, fill out a form. It took only 3 days to get approval. She was able to go to the nearby provider and the provider even took direct payment from UHC.

When we switched to UHC Advantage from regular Medicare, after we had moved to the Villages to stay with Villages Health, my wife's cardiologist became out of network. Nothing could be done about that, we tried, so she had to switch providers. But in the end that worked out really well for us.

The choice between regular vs. Advantage Medicare is a tough one but in the end for us we found Advantage + Villages Health the best choice for us. If Villages Health wasn't around I don't know if we would have gone the Advantage route.

[Carla B]

Just a comment indirectly related. My daughter works for a corporation that handles revenue for large hospital systems. For five years her sole job was to try collect on claims filed with Aetna. They are the worst at paying claims. So I would avoid them.

[gatorbill1]

I don't use TV health, but I do have UHC now after trying some other advantage plans that had very few specialists.
UHC has the most primary care doctors and specialists. Co-pays are a little higher, but no referrals needed for specialists.
Works well for wife and I, no problems with appointments, time with primary care, specialists or procedures needed.

[capecoralbill]

The trouble is, when you are sick, or in the middle of a crisis , I would not exactly be in the mood to contact United Healthcare, getting forms for the doctor to fill out, and then start petitioning Doctors and waiting 3 days to get an approval for a doctor 50 miles closer . As far as finding out WHO is the network or not , I found it daunting, trying to navigate the United Healthcare website to scroll to the right plan, county, City, for the condition I needed. and even if you do locate one , they have a disclaimer that says their online list might not be up to date. I went back to the Medicare with a supplement , it's not cheap though , it costs me $ 207 per month