dillywho |
09-25-2014 09:15 AM |
My Experience
Quote:
Originally Posted by RErmer
(Post 943502)
There is some misinformation in some of these posts. You can switch back and for the between original Medicare and a Meeicare Advantage plan every year if you want to do so, during the Annual Enrollment Period. The issue is that you would not necessarily have a guaranteed right of issue for a supplement (also called Medigap) as you do when first enrolling for Medicare, and your premium will also be higher for the supplement because the rates are set by age at enrollment. Everyone needs to do their own research each year to decide what is best for them, particularly if you have a prescription drug plan (Part D). There's a great tool for this at Medicare.gov: the official U.S. government site for Medicare, but the rates and plans for next year aren't in it quite yet. Note, I am a SHINE volunteer; we would all be happy to assist you at any of our individual counseling sessions (dates and time in the Rec Center news each week).
|
You probably know this, but if you want a supplement after your initial enrollment at 65, you have to furnish proof of insurability. I know, because my husband dropped his when he went back to work. His primary became his employer plan with Medicare as his secondary. He could have also kept his supplement which may have filled in any gaps. I tried to convince him to do it that way, but you know how men are. Long story, short: He had a stroke and was automatically terminated after one year since he was not able to return. He could not get a supplement at ANY price. As a result, guess who was his supplement....us. Everytime he was hospitalized, it was $1684.00...everytime!
Medicare has no cap. His Humana PPO plan does. I have the same plan and they have saved us a lot of money. With the PPO, more doctors take it than an HMO and you don't have to have a referral/approval to choose your doctor. Some procedures do require prior authorization. You pay $65 for the ER and that is credited to your bill should you be hospitalized. Then you pay a set amount for each day for a certain amount of days. Ours plans have a yearly cap of $10,000 for both in and out of network combined. (Your drug charges do NOT count toward your out-of-pocket charges. Those charges work just like Part D through Medicare.) Less if you stay totally within their network. Impossible to do if you ever have need of an ambulance. That, too, is a set amount each occurrance no matter how many times you use them. Medicare does not and that can get really expensive, too.
Some hospitals/doctors do not accept Medicare assignment, meaning they will treat you. They will do your paperwork and Medicare and your supplement pay you direct. Then you pay them the entire bill. I know this because that is how Mayo does it; I was there. Medicare pays you 80% of what they approve and your supplement pays 20% of the approved amount. You pay the rest. I had original Medicare and a supplement at the time.
The Medicare Advantage PPO plan has been a blessing for us, but like anything else it may not be for everyone. I had originally taken Medicare and a supplement. The Medicare premium was being deducted from my SS, I was paying almost $200 a month for the supplement, and $45 a month for Part D. The Medicare deduction pays the premium on our plans now. The rest is inclusive. In the past, there has not been a yearly deductible, but will be $975 in 2015. The drug portion will also have a deductible of $200 ($150 in 2014). My original Medicare and supplement both had yearly deductibles, which kept rising each year.
|