[champion6]

Originally Posted by gerryann;9***63

I know standard medicare pays 80% and the supplement picks up the rest. What drug plan or what supplement do you have that covers drugs? ( with a co-pay)

The supplement doesn't cover the drugs. The Part D prescription drug plan does.

Honestly, there is no single Part D that is the "best" because these plans seem to change every year. Which drugs you take makes a big difference, too. I have been on Medicare two years and I am on my second Part D plan. During Open Enrollment, I go to medicare.gov and plug in my drugs and look for the cheapest Part D for me. You should too.

[2BNTV]

Originally Posted by shcisamax

What do you mean you can't switch back? Do you mean if you take an advantage plan you are stuck for the rest of your life with it? You can't change it during the yearly open enrollment?

No.

I was informed if one wanted to switch to straight Medicare from a Medical Advantage Plan, there is no guarantee you will be accepted. You can switch back to a Medical Advantage plan but you can't apply back to straight Medicare again. One bite at the apple.

You always have the options of switching for one Medical Advantage Plan to another every year, to suit your needs. That is your right, during the open enrollment period.

Everyone needs may shift from year to year, so one needs to select the best plan, for themselves.

[NYGUY]

Originally Posted by alanmcdonald;9***96

Is the AARP plan through United Healthcare and will it work with The Villages Medical Centers?

Yes,the AARP plans are United Healthcare plans(United merely pays AARP for the use of their name) and yes The Villages Health (the health care centers) accepts these plans.

[CFrance]

Originally Posted by 2BNTV

No.

I was informed if one wanted to switch to straight Medicare from a Medical Advantage Plan, there is no guarantee you will be accepted. You can switch back to a Medical Advantage plan but you can't apply back to straight Medicare again. One bite at the apple.

You always have the options of switching for one Medical Advantage Plan to another every year, to suit your needs. That is your right, during the open enrollment period.

Everyone needs may shift from year to year, so one needs to select the best plan, for themselves.

Joe, please define what you mean by "straight Medicare." Thanks.

[JoMar]

I think the term is original medicare

[shcisamax]

But Medicare can't refuse you, can they? Are you referring to the supplemental plans that might refuse you?

[wendyquat]

Hubby and I have been on "straight" medicare plus UHC supplement F plans since turning 65, 7 and 5 years ago. We've never paid but one medical bill out of pocket and that was $12 for a test not covered my medicare. Btw, they must tell you up front that a particular test or procedure will NOT be covered by medicare and get you to sign that you understand, or they CANNOT bill you for it! This is assuming you are seeing a medicare participating doctor, which we do. We've never come across a doctor around here that does not gladly accept Medicare or our UHC supplement.

A couple of years ago I investigated switching to a UHC Medicare advantage plan to save money. No one was able to tell me that I could switch back to "straight" Medicare if I was dissatisfied. My cardiologist told me that they were being dropped from the advantage plan list of participating doctors beginning in January so that was a game changer for me.

If you have significant health issues IMHO you would fare better with "straight" (original) medicare plus a good supplement.

[2BNTV]

Originally Posted by CFrance

Joe, please define what you mean by "straight Medicare." Thanks.

"Original" instead of "straight" would have been a better choice of word.

[jblum315]

Originally Posted by shcisamax

What do you mean you can't switch back? Do you mean if you take an advantage plan you are stuck for the rest of your life with it? You can't change it during the yearly open enrollment?

I switched to an Advantage plan and then switched back to original Medicare with AARP supplement Plan F. It was complicated and needed many phone calls but I got it done.
You should definitely talk to one of the SHINE counselors. They have regular meetings at rec centers.

[RErmer]

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).

[billybye]

Originally Posted by pbkmaine

I know some of you have experienced problems with medical providers in The Villages, but I would like to turn that discussion on its head. Who out there has a Medicare Plan or Medicare Advantage Plan with primary care providers, specialists and hospitals you think are REALLY GOOD? My husband currently has The Villages UHC Medicare Advantage Plan. He was a bit alarmed when he was told that the ONLY ear, nose and throat physician who would accept his insurance was in Tavares. We have been told this is an issue with specialists in general. So we are exploring alternatives. Recommendations would be most welcome.

Need to be careful with advantage plans, especially Villages UHC, they cut out a lot of specialists, trying to get you to use their coming network.
I went to Florida Blue who had all my doctors on it, especially Citrus Cardiology, who I like a lot.

[dillywho]

Originally Posted by RErmer

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.

[cameo37@gmail.com]

I'm thinking about signing up for the Medicare advantage ppo, first time for me. Hope I'll be happy with it.

[Madelaine Amee]

We have regular medicare and AARP(UHC) Plan J (which is no longer available). Only bill we have ever seen was for $72. I was a surgical patient at Mayo for over two years and they do not accept the Medicare payment schedule, but my Plan J picked up all but the $72. Costs us a little over $300 a month, necessary evil, and great peace of mind.

IMHO health care costs are just another gamble - (will you get sick), like the stock market - (will it tank), how much risk are you prepared to take!

[CFrance]

Originally Posted by Madelaine Amee

We have regular medicare and AARP(UHC) Plan J (which is no longer available). Only bill we have ever seen was for $72. I was a surgical patient at Mayo for over two years and they do not accept the Medicare payment schedule, but my Plan J picked up all but the $72. Costs us a little over $300 a month, necessary evil, and great peace of mind.

IMHO health care costs are just another gamble - (will you get sick), like the stock market - (will it tank), how much risk are you prepared to take!

Thank you for answering a big question of mine about Mayo. We have supplemental plans on top of Medicare that are accepted anywhere in the country. So many people have stated that Mayo does not take Medicare, but I have wondered if you have something other than an advantage plan if you are covered there.