Who has a Medicare Plan that really works?
 

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.

I have never been told that and mine covers everything I have had done. I have regular medicare and AARP Plan F

Check out SHINE (Serving Health Needs Of Elders) at SHINE - Home. The have times at the rec centers that you can go for individual counseling based on your needs. Very helpful. Staffed by volunteers and there is no charge.

Unfortunately each provider and the physicians and specialists they have in their network varies and changes from year to year. We have the Florida Blue Advantage plan and were considering changing to the United Healthcare Advantage plan. 2 1/2 years ago my wife had a successful bout with cancer and our hospital and surgeon was Moffitt Cancer Hospital in Tampa. At the end of 2013 when deciding what to do we found that Moffitt dropped United Healthcare as a provider. The reason we were given was UHC was not willing to pay the fees for procedures that Moffitt wanted. We stayed with Florida Blue as my wife continues to have follow up tests that we need covered. This annual change that providers, facilities, and physicians will continue to hop-scotch with, along with premiums, co-pays etc. will see no end soon. If you don't mind paying hundreds of dollars per month for a medicare supplement plan, that will "at this time" allow you to see most any Doctor of your choice, is another option. Just be mindful of the fact that big big bucks are being taken out of medicare funding to help fund Obama Care. This fact alone will have Advantage Plans and Supplemental Plans increasing premiums and adjusting coverage to make up for this loss of revenue. What this all means is every fall during the "enrollment period" you will need to review your specific plan and medical needs to be assured your coverage is where you want it to be.

I have aarp plan n and I have had three surgeries and everything has been covered. They also pay my gym membership at anytime fitness on 466. Every specialist I have seen takes this and all of the doctors are here in the villages.

I have Humana PPO just had a hip replaced cost me 300.00 thought that was pretty good.

standard medicare and AARP supplement and have not had to put a hand in my pocket for anything except co-pay on drugs (part D) for the last 14 years!!!!

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)

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

IMHO, after 40 years in Healthcare, your post says it all. And the cost is less out of my pocket than when I had a fabulous corporate Heath plan.

The Florida Blue Advantage Plan has a prescription drug plan that has a $5 and up co-pay for tier 1 drugs and it goes up from there depending on the drug and tier it is in. As I stated earlier the best way to find what plan is best for you is to go directly to the providers (FL Blue/United Healthcare/etc) during the 2015 enrollment period from 10/15-12/7/2014. Get all the information and do your due diligence by comparing the plans. You can go to Shine meetings as I did but all they will do is explain the basics of what the Advantage Plans do, not what the different plans specific benefits are. Back to school. Homework!

My drug plan is AARP through UnitedHealthcare. They have a number of plans that they can recommend depending upon your needs and wishes.

Medicare plus a supplemental plan and drug coverage will cost approximately $300/month, (just a guess as I don't have this plan). You have piece of mind but are paying $3600 per year. for all of your medical needs. If one is constantly sick or has a known expensive condition, that is the way to go.

If one is reasonably healthy, a Medical Advantage cost is $104.90 per month that includes drug coverage. One will have to put their hand in their pocket but not to the tune of $3600/year. Out of pocket maximum is $4400 for the year, with Fl Blue HMO plan, (worst case scenario).

If one feels they will be needing to switch to Medicare, you only get one bite at the apple. You cannot switch back and forth between straight Medicare and Medical Advantage Plans.

Everyone has to decide what is best for them.

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?

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.

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.

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.

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

I think the term is original medicare

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

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.

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

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.

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).

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.

My Experience
 

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.

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

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.

Hi there - Mayo does take Medicare payments, but they do not accept the reimbursement amounts that Medicare pays for their services, so this is passed along to your secondary. In my case all was well because the 'J' plan picked up almost everything, even the final robotic surgery.

But, got to admit it is scary, there is a lot of paperwork you have to fill in and send on to Medicare and your secondary, and thankfully the other half did all that. They also have an excellent financial office who will sit with you and help with ways to pay for your treatment - after all not everyone has Medicare or secondary insurance - I wonder what happens now with the Government health care in place?

I just found this link http://www.mayoclinic.org/patient-vi...rance/medicare which is an excellent explanation of how Mayo/Medicare work. This is an even better and easier to understand outline of Mayo and Medicare. http://www.mayoclinic.org/documents/...u/doc-20078770

The answer is to stay on regular medicare and use a suppliment, we have AARP which is processed by UnitedHealth Care. we have Humana for RX.s. My husband also qualified for the VA medical as a back up if need be, he sees the va Dr once a year. I had 6 surgeries last year and everything was paid 100 per cent. It will cost more but you can pick a Dr or hospital anywhere in the US. No Hassel.

I have Medicare and a Blue Cross Medigap Plan C and it works great everywhere I have been. Yes it is more expensive than most advantage plans but for me its worth it. NO restrictions as to where I have treatment. My choice , not dictated by a medical plan.

Have had in access of over $200K in bills and never paid any money other than my premiums. It really depends on you. One caveat..If you join an Advantage plan and become really ill you might not be able to switch to some other coverage later because of the underwriters.

Good Luck!

Supplements such as BC and AARP/UHC do not restrict access to docs or facilities. If the doc accepts Medicare, and is in Atlanta, Boston, LA or elsewhere you can go to that doc or facility.

Another voice for AARP plan F - My wife and I pay $334 per month - I too have had Cadillac corporate plans and this is the best ever.

At age 65 I opted for the AARP UHC plan's highest option, whatever that is or was since the options have changed a bit since then. Although I currently take no meds whatsoever except an antibiotic when needed I am paying for the Rx plan as well. One never knows...

When I turned 65 and signed up I could have gotten into excellent somewhat lower cost plans offered by a couple of different professional organizations but opted to go with AARP based on the 'too big to fail' principle.

So far, so good. I want to be able to see a physician of my choice wherever I am as I travel frequently and spend time in several states where I have needed medical attention.

I believe you are describing one of the problems with The Villages United Healthcare Advantage Plan (in-network providers). If you are otherwise happy with UHC, you could switch to one of their other Medicare Advantage plans (which are also accepted by The Villages Health), i.e. AARP Medicare Complete Choice Plan 2. This is a PPO, with a much larger in-network provider base, including specialists (that you do not need a referral for).

Best way to see an estimate of your yearly costs is on the Medicare/gov site and put in your medications.
I am now with Florida Blue, Freedom would give me $62.00 a month back, but my drugs on the Freedom plan would cost me an extra $800.00 a year.
I will probably stay with what I have, but it is very confusing when talking with agents who sell one plan or another. The Medicare site is the easiest way. It's not perfect, but pretty good for a government site.

We Use United Healthcare Medicare Advantage, PPO, this allows us to go to any Dr we want. Obamacre has nthing to do with the prices of The Medicare ASdvantage programs. It all depends on the tpe of program you select. In fact The affordable cRae acr subsidixes all medicare advantage programs. We have never had a problem with seeing any specialists in
witihin the Villages community or outside The Villages or any medical Facolities as long as you selct the PPO not the HMO. Good Luck

yes