Originally Posted by Pugchief (Post 2306026)

@golfing eagles and @BigDawgInLakeDenham thanks for your opinion. I, too, spent my entire career in health care delivery and have the opposite view: I would NEVER sign up for an HMO of any kind, including Medicare Advantage unless it was my only option. Yes, you will save some money. But you will also jump thru more hoops to go anywhere beyond PCP, and I have also heard horror stories of people being denied care they wanted/needed by the HMO. I'm sure it is a good option for many folks, but definitely not me.

Originally Posted by CoachKandSportsguy (Post 2306044)

Correct, currently BCBS MA is denying paying for cancer validating exam requested by one of CoachK's direct report's husband's doctors, who is forced to go onto Medicare to get the $7,000 validating exam paid for. . private employer provided insurance refused to pay. . .

Unfortunately, there are hospitals which has stopped taking UHC insurance plans as they don't pay promptly or at all. . another friend who's wife has been a nurse in administration for her whole life, had to switch to medicare to get his doctors' requests paid for after this heart by-pass operation which saved his life.

times are changing, and UHC is profit over patient. . don't believe anything to the contrary with UHC

Advantage plans only work for the healthy with no issues. . and when you do have issues, be sure they are regular everyday issues. .

Originally Posted by CoachKandSportsguy (Post 2306044)

Correct, currently BCBS MA is denying paying for cancer validating exam requested by one of CoachK's direct report's husband's doctors, who is forced to go onto Medicare to get the $7,000 validating exam paid for. . private employer provided insurance refused to pay. . .

Unfortunately, there are hospitals which has stopped taking UHC insurance plans as they don't pay promptly or at all. . another friend who's wife has been a nurse in administration for her whole life, had to switch to medicare to get his doctors' requests paid for after this heart by-pass operation which saved his life.

times are changing, and UHC is profit over patient. . don't believe anything to the contrary with UHC

Advantage plans only work for the healthy with no issues. . and when you do have issues, be sure they are regular everyday issues. .

Originally Posted by BigDawgInLakeDenham (Post 2306048)

Sorry but your story is BS. If RN wife switched to Medicare it has no impact and no coverage for anyone but her. Please provide factual personal experiences...please

Oh and mine is a Nurse Administrator and I would not want her to run my code

Originally Posted by golfing eagles (Post 2306025)

You'd win both bets, but I can't pay up since I'm spending 100x as much each month as OBB. (Actually, I think she owes me a thank you for subsidizing her premium:1rotfl::1rotfl::1rotfl:)

But then riddle me this: With all my expertise, I get Medicare in 2 months and have already signed up for my advantage plan. Am I stupid? Ignorant? Gullible? (on second thought, don't answer that:1rotfl::1rotfl::1rotfl:)

Originally Posted by CoachKandSportsguy (Post 2306051)

nice try , I didn't give you any fine details, but yes, both stories are very very true for both nurse wives and husbands scenarios who work/worked at hospitals. Sorry, I can't give you names to counter your response for your assumed all knowing knowledge as well as highly judgmental typing.

but continue on, we will hang on every word you type. . .

Originally Posted by CoachKandSportsguy (Post 2306044)

Correct, currently BCBS MA is denying paying for cancer validating exam requested by one of CoachK's direct report's husband's doctors, who is forced to go onto Medicare to get the $7,000 validating exam paid for. . private employer provided insurance refused to pay. . .

Unfortunately, there are hospitals which has stopped taking UHC insurance plans as they don't pay promptly or at all. . another friend who's wife has been a nurse in administration for her whole life, had to switch to medicare to get his doctors' requests paid for after this heart by-pass operation which saved his life.

times are changing, and UHC is profit over patient. . don't believe anything to the contrary with UHC

Advantage plans only work for the healthy with no issues. . and when you do have issues, be sure they are regular everyday issues. .

Originally Posted by BrianL99 (Post 2305986)

Yeah, I waited years to get my free Medicare, until I found out it costs me over $630/month. That took some of the fun out of turning 65.

Originally Posted by Rainger99 (Post 2306039)

$15,828/ month!! That would be $189,936 a year!!

Please tell me that is a typo!

Originally Posted by Pugchief (Post 2306026)

@golfing eagles and @BigDawgInLakeDenham thanks for your opinion. I, too, spent my entire career in health care delivery and have the opposite view: I would NEVER sign up for an HMO of any kind, including Medicare Advantage unless it was my only option. Yes, you will save some money. But you will also jump thru more hoops to go anywhere beyond PCP, and I have also heard horror stories of people being denied care they wanted/needed by the HMO. I'm sure it is a good option for many folks, but definitely not me.

Originally Posted by tophcfa (Post 2306070)

Ya, Medicare, Medigap, and Pard D prescription is going to cost my wife and I about $800 per month for great national coverage with about a $250 max out of pocket each per year. We now pay over twice that for our Obamacare plan with a limited local network and about $8,000 max out of pocket each per year. That makes Medicare look dam good compared to our current options.

Originally Posted by rustyp (Post 2305850)

Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

Originally Posted by BigDawgInLakeDenham (Post 2305814)

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

Originally Posted by BrianL99 (Post 2305986)

Yeah, I waited years to get my free Medicare, until I found out it costs me over $630/month. That took some of the fun out of turning 65.

Originally Posted by TVTVTV (Post 2305794)

I am not yet eligible for Medicare, but will be early next year. Currently, my BCBS (FL Blue) individual Silver PPO medical insurance only covers specialists within the BCBS in-network list, so I am quite limited in my choices, and don't have my preferred specialist in the network. If I choose BCBS or any other supplement with original Medicare, am I understanding that as long as the specialist accepts original Medicare (which most do), that there is no more "in-network" to consider with a BCBS supplement? This would definitely widen the specialists I could see. I am specifically asking about supplements here, not advantage plans.

Originally Posted by OrangeBlossomBaby (Post 2306077)

For us, once we're on Medicare, our premiums will be higher than they are now because of our subsidies on the ACA marketplace. On the other hand, if we didn't have subsidies, we'd have to pay around $1800/month for insurance. That'd eat up one of our social security checks every month, and dip into another one by a few bucks. We'd have to do without insurance at all and just hope that we never need health care.

We paid in all our lives for Medicare, did everything we were supposed to do, but circumstances forced us into a much more modest retirement income than we were expecting.

To whoever was asking about co-pays - it's insurance-dependent. You pay whatever your insurance company says you pay. Mine says $85 per treatment, per specialist visit, per lab test. So treating my skin cancer will set us back around $2800, over a 6-week period Including the test/biopsy, consultation for treatment, weekly 10-second visit with the doctor who walks in, doesn't even come within 5 feet of me, says "looks good, see you next week" and walks out again. INFURIATING that they even have the right to bill anyone for that.

Originally Posted by BigDawgInLakeDenham (Post 2305814)

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

Originally Posted by rustyp (Post 2305850)

Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

Originally Posted by Marine1974 (Post 2306188)

I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist. .

Originally Posted by rustyp (Post 2305882)

55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

Originally Posted by retiredguy123 (Post 2305944)

Note that the OP's only question was, if they have original (traditional) Medicare and a Medicare supplement plan, is there a network of providers that they must use to be paid by the supplement plan? The question has already been answered and the answer is no. If the provider accepts traditional Medicare, then the supplement plan will cover all or part of the coinsurance.

Originally Posted by Indydealmaker (Post 2306191)

How is that particularly good?

Originally Posted by TVTVTV (Post 2306202)

Thank you to the few of you who answered my direct question. I wasn't looking for advice on every other aspect of health care, just a direct inquiry if "in network" and "out of network" exists with any Medicare supplement (= Medigap). I have a great PCP that I see regularly. I have done a lot of reading on Medicare, and will be in contact with SHINE. I know everyone's situation is different, so what fits my needs may not be the choice for someone else. Since PCP's and specialists may move or join another company, they may be in an Advantage plan one year and not the next. When I am faced with a medical crisis, I want to decide where in the country I want my treatment. For example, there don't seem to be any Advantage plans locally that would permit me to go to the Mayo Clinic if that's where my PCP said had the best treatment. I'd have to use an "in-network" provider that may not be my preference. (If there is one, no need to tell me which one). This is just an example, and could apply if you wanted to go somewhere with advanced treatment options for a myriad of health issues.

I really appreciate your direct answer to my general question, which was if I choose a specific company (like FL Blue or UHS) SUPPLEMENT, then I can go anywhere and see any PCP or specialist (yes, if they are accepting new patients, etc.), as NETWORKS don't apply with supplement (medigap) plans, but do with Advantage Plans. I will continue to research.

Originally Posted by Indydealmaker (Post 2306195)

Just a marketing concept. Your healthcare is dictated by the profits. Advantage companies don't make money if you require more care than your allotment. Logic says that must effect the care.

Originally Posted by rustyp (Post 2305882)

55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

Originally Posted by Indydealmaker (Post 2306195)

Just a marketing concept. Your healthcare is dictated by the profits. Advantage companies don't make money if you require more care than your allotment. Logic says that must effect the care.

Originally Posted by biker1 (Post 2306210)

Just in case you didn't realize, all of the Supplemental Plans are identical in terms of coverage. In other words, one insurance company's Plan G is identical to another insurance company's Plan G (based on county you live in). The cost, however, will vary. In addition, some of the insurance companies may allow you change from one plan to another (say move from Plan G to Plan N) without going through underwriting. For example, UHC in Florida allows this.

Originally Posted by TVTVTV (Post 2306226)

Yes, thanks for the reminder of that. So for example, all G Supplements have = and identical coverage, and your choice is the company and price (based on the county you live in). With Advantage plans, you need to consider more: company, price, specific coverage and co-pays, possible perks, perhaps specific Rx sites you can use, and most importantly, the PCP's, specialists, and facilities you have in-network when you need health care.

Originally Posted by TVTVTV (Post 2306226)

Yes, thanks for the reminder of that. So for example, all G Supplements have = and identical coverage, and your choice is the company and price (based on the county you live in). With Advantage plans, you need to consider more: company, price, specific coverage and co-pays, possible perks, perhaps specific Rx sites you can use, and most importantly, the PCP's, specialists, and facilities you have in-network when you need health care.

Originally Posted by Dusty_Star (Post 2306250)

Teeny, tiny bit more complicated, you also purchase Plan D for drug coverage, & that choice will dictate pharmacies, but I think they also allow you to choose online or mail in pharmacies. Anyone know better, please chime in.

Originally Posted by golfing eagles (Post 2306073)

The Plan I signed up for is a PPO, not an HMO. Big difference

Originally Posted by Marine1974 (Post 2306188)

I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist.

Originally Posted by retiredguy123 (Post 2306255)

I think you are referring to Medicare Part D, not Plan D. Part D is a separate drug insurance plan, not a supplement plan for Medicare Parts A and B. Medicare Part A is for hospitalization, Part B is for doctor visits, labs, surgery, etc., and Part D is for prescription drugs. You can buy a supplement plan to cover your coinsurance for Parts A and B, but I don't think you can buy a supplement plan for Part D.

Originally Posted by Dusty_Star (Post 2306278)

Right, for regular Medicare you can buy a supplement also called Medigap policies, but you also buy a Plan D - drug plan. Plan D is the supplement for drug coverage, without which prescription drugs can be very expensive. Plan D type coverage for prescription drugs is often included in Advantage plans.

Originally Posted by Marine1974 (Post 2306188)

I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist. .

Originally Posted by Pugchief (Post 2306274)

Yes, it is a big difference. Maybe I misunderstood; didn't you say you had a Medicare Advantage plan? And if so, aren't those essentially HMOs?

Hallmarks of HMOs are:
limited network of providers, zero benefits out-of-network, and "gate keeping" by PCP. Please correct me if any of this is untrue.