[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.