Talk of The Villages Florida - Rentals, Entertainment & More
Talk of The Villages Florida - Rentals, Entertainment & More
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Getting a PCP is a no-brainer. There are dozens and dozens of them, and you just have to pick one that accepts your insurance. There aren't dozens and dozens of specialists in each specialty, and many of them don't accept medicare at all. For instance - I know I need a hip replacement. My PCP doesn't do those. I need a specialist for that. So when it was time for me to select my health insurance plan, I had to consider the cost of the hip replacement in mind. They run around $25,000 for people who don't have any insurance and aren't in a poverty level to get a break on the price. My insurance has super low premiums - only $17/month. No deductible. But an out of pocket expense max of $9700. That means - if I need a hip replacement THIS year, I'll pay $9700, instead of $25,000, and other medical expenses for the year won't cost anything at all. If I don't need the hip replacement this year, then I'll pay my co-pays throughout the year when I go to the doctor, UNTIL I've paid out $9700, and then I'll pay no more til next year. Right now I'm racking up $85/DAY in expenses because I'm undergoing radiation treatments for skin cancer. My PCP doesn't provide that service, a specialist is handling that. That's the co-pay for specialist services on my plan. I'm not on medicare yet, not old enough yet. But the explanation of "why" people are concerned about specialist access is the same no matter which type of health insurance you have. |
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#17
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#18
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We did a ton of research and even talked with people on this plan, which I doubt you did. We even talked to SHINE, they said it was a very good option for us. It's also highly rated by Medicare. We love the wellness benefits as well. You're painting with a broad brush, and you're not fully informed. All advantage plans differ by a lot.
__________________
"Attack life. It's going to kill you anyway." Steve McQueen |
#19
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Obamacare income testing.
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#20
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Also, with a part g Medigap plan, if that condition runs up a million dollars in medical expenses, all you pay is your approximately $250 annual deductible and never see another bill. |
#21
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How Many Physicians Have Opted Out of the Medicare Program? | KFF According to this very few physicians have opted-out of Medicare. Have you found this to be different in The Villages? |
#22
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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.
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#23
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#24
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It's a crappy plan. The basics are covered, I have to pay $85 per treatment, test, and specialist visit, and I have to keep paying that until I've hit $9700 out of pocket. That's just for me. Hubby has his own $9700 out of pocket, so the family benefit doesn't begin until we've eaten through $19,400 combined.
It's a Florida Blue bronze POS. And yes we're low income - not poverty though, or else we'd qualify for Medicaid. Last year the exact same plan was $187 premiums every month. I don't know why it went down so much this year but I'm not complaining. The year before, we were paying $267/month for a Silver plan. |
#25
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#26
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Advantage Plans are cheaper & give away "freebies" as you mentioned. The fact that SHINE said "they're a very good solution for you, doesn't make them better or even equal to Medicare + a Supplemental. It means that in your particular financial/health position, it's a good option. They're a cost based solution, for folks trying to save money. There's nothing else anyone needs to know about them. |
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#29
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#30
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I'm not sure that anecdotal evidence, dispels anything. As with any business (& you surely know medicine has become a "business"), human nature and human competency, always trumps theory. In this case, the theory being that Advantage programs should be offering a level of medical care, consistent with other options. They all don't and at minimum, all depend on the competency, dedication and (your word) effort, of one's PCP. As for "directing one's healthcare", I agree that folks shouldn't be relying on Google, but on a trusted, competent physician ... unencumbered by the corporate policy of a profit-making conglomerate. (& I understand that Medicare has it's own standards and "rules", but manipulating and navigating Medicare rules, when the government is the overseer, seems much simpler to do, than negotiating/arguing/challenging/maneuvering through a structure controlled by competent, corporate America professionals.) We can agree to disagree. (& I'll bet a dollar, that the $1700/Month you're paying for your health insurance, with that huge deductible, allows you to see any physician you want and bet another dollar, it's a BCBS program!) Last edited by BrianL99; 02-28-2024 at 11:55 AM. |
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