Medicare Advantage Plans
 

In January, I have to make a decision as to which medicare advantage plan to go with due to my husband's retirement and therefore I will transition to post medicare. My husband and I have been reading reviews for United Health Care and Humana. My head is ready to explode after reading the awful reviews of both of these plans.

I don't plan on using The Villages Health Care system as of now because the current Doctors that I see are not in their system. I just want to use this plan for my doctors that I have been going to since I have moved to The Villages.

The common "theme" of the reviews is that people verify with the insurance company that their provider is in network. Come time for the bill to be paid, both plans claim the providers were "out of network" and will not pay the claim.

What has your experience been with either United Health Care Medicare Advantage plan or Humana Medicare Advantage plan?

Good luck - I would not be taking advice from here. My experiences is 180 degrees from what most have posted on here for this subject. Everybody's an expert but they don't want to give up their doctor or we are not switching insurance form our previous employer etc. Then there is the crowd that believes you have to go to some fancy high class institution to get good care including the cure for a hangnail. Find someone down here with similar background as you and your previous employer and area where you lived plus has a couple year head start on you. Be sure to ask when being sited chapter and verse if their experience truly happened to them or "I heard this from ". A good place to start is SHINE. As an aside I believe UHC is the largest health insurance company in the USA.

We have UHC Advantage and use Villages Health. This has worked out very well for us both for everyday health issues and for major health issues too. When we transitioned from regular Medicare to Advantage my wife had to change one of her specialist which was a bit of a worry, but in the end it worked out just fine.

The UHC Advantage plans come in two kinds. The ones that are zero cost only pay for in network providers. You can get exceptions for out of network providers (we did once, it was a phone call and a form, pretty easy) but there is no guarantee it will be approved. But in any case any Advantage plan has to provide all the services that regular Medicare does even if only an out of network provider is needed.

However there are other ones that will also pay for out of network providers but they are not zero cost and have higher copays and higher out-of pocket expense limits.

We've had the zero cost plan for the last 4 years and getting services and specialists haven't been a problem.

You have to check with the current doctor to see if he or she is in-network even if the UHC plan lists them in network, the list of doctors in the plan documents are not always correct. So you will have to ask your current doctors if will theyaccept any of the insurance plans you want to use.

You mention going to Medicare Advantage... if you instead go with regular Medicare you can go to any doctor that will accepts Medicare and will accept you as a patient. That might be the easiest way to stay with your current doctor.

I have seen the term Zero Cost being used regarding Medicare Advantage programs. I do not like this description since I have been paying toward Medicare since it began through payroll deductions.. Since I have retired and am on Social Security (which I also paid premiums all my working life), I also have a monthly premium for Part B Medicare deducted from my SS payment. For 2018 that premium was $134/Mo which is $1608 per year. Without going into details and recognizing that each persons data is unique, it is likely that I have at least $2000 invested into Medicare Part A and Part B benefits. Then if I select a "Zero Cost " Advantage program, I am really paying the $2000 for this program.

Just to be clear the Zero Cost refers to the cost of a supplemental plan that covers the 20% and other things that Medicare doesn't cover, not to the cost of Medicare.

Some supplemental plans cost zero and some cost more that most people pay for Medicare part A and B.

Not my understanding. It is my understanding that when you sign up for Advantage you no longer have Med Part B coverage from the government. Part A Probably. Supposedly, the Advantage program gets to cover the entire Part B.


This/ My understanding is why some one told the OP Good luck trying to get info here.

OP, contact SHINE for unbiased information, what works well for one person maybe a disaster for another. We had an Advantage plan for a while, had problems, found out we could go back (NOTE: this is not always the case), so we went back to Medicare and a supplemental.

SHINE - Home

Good luck with your quest.

Yes, when you sign up for Advantage you no longer have coverage directly through either part A or part B. But the Advantage plan has to, by law, provide all the coverage you would have had with part A and part B. In general Advantage provide coverage beyond what part A and B do. However you still have to pay for part A and B if you have an Advantage plan and what is covered is the same as what would be covered if you had regular Medicare.

See the paragraphs at the beginning of each of these pages.

What Part B covers | Medicare

What Part A covers | Medicare

Hubby and I will be speaking to a SHINE representative this week at the Lake Miona Rec center. Thanks letting me know about SHINE in your previous post.

Thanks to all who have replied. My main concern about the Medicare Advantage plans is the awful reviews hubby and I have read about them. People claim they verified that providers are in network then the insurance companies insist those said providers are NOT in network. I don't know if I can trust the information I receive regarding who is in network and who is not in network.

Have any of you had problems with the providers not being in network after you were assured they were in network? I'm referring to any of the Medicare Advantage plans such as United Health Care, Humana and Aetna.

From a provider standpoint it does not matter which plan. Doctors come and go all the time out of any provider's plan throughout the plan year. Again UHC is the biggest health provider in the USA. Probably a correlation to the most in network Vs size - not sure. As far as your first post some statement that the ins co refuse to pay because of out of network - not likely. Most pay but cost you higher copays (or the difference) due to out of network. Now you need to compare out of pocket maximums to safeguard yourself against that situation. Go to the hospital and ask are you in network. Most likely yes. Now ask is everyone involved in my hospital care in network. You won't get a straight answer to that. I had an emergency visit to TV a few years ago. Hospital in network. Emergency room doctor out of network. Perhaps the emergency room doctor on the previous shift was in network. How are you going to control that ? Bottom line for me is I have TV UHC. The best and easiest insurance I've ever dealt with. The plan works very well here and in New York State when I do my snowbird thing. Love my doctors and specialists.

Yes, quite some time ago before we moved to the Villages we were in an Advantage plan and my wife's doctor sent her to a provider for a prothesis. About two months after the visit we got a bill for about $800 with a statement that coverage was denied because the provider was out of network. She called her doctor about it and in the end the company allowed the claim I guess because her doctor thought the provider was in-network. I forget which company it was.

Two years ago the same prothesis needed replacement and UHC Advantage wanted my wife to travel to a provider in Mt. Dora which is about an hour drive for us.

She found a provider nearby in the Villages that was not in network and would not accept UHC Advantage. She called UHC and told them she didn't want to go all the way to Mt. Dora when there was another provider right nearby... that is no medical need just convenience. UHC said ok, fill out a form. It took only 3 days to get approval. She was able to go to the nearby provider and the provider even took direct payment from UHC.

When we switched to UHC Advantage from regular Medicare, after we had moved to the Villages to stay with Villages Health, my wife's cardiologist became out of network. Nothing could be done about that, we tried, so she had to switch providers. But in the end that worked out really well for us.

The choice between regular vs. Advantage Medicare is a tough one but in the end for us we found Advantage + Villages Health the best choice for us. If Villages Health wasn't around I don't know if we would have gone the Advantage route.

Just a comment indirectly related. My daughter works for a corporation that handles revenue for large hospital systems. For five years her sole job was to try collect on claims filed with Aetna. They are the worst at paying claims. So I would avoid them.

I don't use TV health, but I do have UHC now after trying some other advantage plans that had very few specialists.
UHC has the most primary care doctors and specialists. Co-pays are a little higher, but no referrals needed for specialists.
Works well for wife and I, no problems with appointments, time with primary care, specialists or procedures needed.

The trouble is, when you are sick, or in the middle of a crisis , I would not exactly be in the mood to contact United Healthcare, getting forms for the doctor to fill out, and then start petitioning Doctors and waiting 3 days to get an approval for a doctor 50 miles closer . As far as finding out WHO is the network or not , I found it daunting, trying to navigate the United Healthcare website to scroll to the right plan, county, City, for the condition I needed. and even if you do locate one , they have a disclaimer that says their online list might not be up to date. I went back to the Medicare with a supplement , it's not cheap though , it costs me $ 207 per month

Not even close to my experience. When traveling between TV and New York a 2 minute phone call before I leave switches me onto the NY network which then puts me in network there and vice versa. No referrals need for any specialists. Again did this really happen to you or are you relating to something you heard or read about here ?

This is an over the top description of how UHC Advantage works. We've had a number of major medical crises and UHC Advantage handled them all very well.

Getting a prescription for a prothesis filled is not a crisis.

another thumbs up for uhc

OP, I definitely agree with the advice to contact a potential doctor's office directly to confirm that they accept your insurance rather than relying on a published list or even calling the insurance company's help line. The online lists are very unreliable.

While I was researching Medicare, I also made the mistake of speaking to an insurance agent I thought was independent but who works for UH. The entire process was very confusing for me, even after talking to SHINE.

I went with UH Advantage/Villages Health strictly on price; it was about $200/month less than the Medicare supplements I looked at. It has been a bit of a struggle to find specialists here who accept my WellMed UHC plan, but that's partially on me because I wanted to stay with my primary care doctor and don't use the Villages Health system itself.

I've had one instance of UH denying authorization for an MRI and me having to argue about it with them. That happens more frequently with Advantage plans than it does with original Medicare.

Choosing health care involves a bit of predicting the future with regard to what one's health care needs might be.

Best wishes to you.

Half of the doctors graduated at the bottom half of their medical school classes. I want to be able to choose my doctor, preferably one who went to an excellent medical school in the good old USA and graduated near the top of his class. I also may need one in any one of four states. Thus I choose Medicare plus the UHC supplement.

When my wife was on regular Medicare she had a couple of echo tests denied because it they were too soon after the previous one. The same thing happened once after she transitioned to Advantage.

So I don't think test denials have anything to do with Advantage vs. regular. Advantage has to run under the same rules as regular Medicare and CMS, that runs Medicare, sets the rules for when and how often tests can be done.

The best recommendation is to speak with a licensed insurance broker that represents many plans.

They can discuss the pros and cons, listen to your concerns and help you make an informed choice.

SHINE is good also but they cannot discuss specific plans, they aren’t appointed by specific company’s. Only brokers are.

They have to take an annual test with each company they represent to know all the specifics

Medicare Advantage (MA) takes the place of regular Medicare. If you want to keep your current doctor and they are not a provider under your MA plan, your plan won't pay. I have a UHC supplemental plan and can see whatever doctor I want to see who accepts traditional Medicare. The best advice is to call SHINE. They are unbiased and can explain both systems.

Have been 100% satisfied with the United Healthcare Medicare Advantage plan.

People always complain about their healthcare coverage regardless of their plan.

I opted for United Health Advantage through the Villages the only drawback has been dentists , some do not participate , I keep my own Doctors and pay 82.00 per month and receive no deductible medications , no copay on Doctor visit except specialist and 15 for them had a pacemaker installed no cost very satisfied with my program.

My wife and I are snowbirds and wanted a plan that can travel to different States. We have Medicare as our primary and UHC/AARP as our secondary. Under AARP we have two different tiers since one of us requires more health care than the other. As long as the Dr. accepts Medicare we are covered in any State. Also, for our Part D coverage we have Silver Script for one of us and Express Script for the other. Chose these two based on our RX's and what tiers they were in.

Some MA plans won't pay out of network providers and some will.

Many doctors do not take advantage plans --They are HMO’s or PPOs. I have had straight Medicare with United as Medigap plan and have never had a problem getting any doctor I want in any state that I want.

The comments are interesting. We decided to stay with our original Ins. that I started with when I retired with 11 yrs. ago. A couple of comments answered the question that I was always wondering about, is it hard to find a Dr. in network to get us less pay out of pocket. We didn't take any of these, we stayed with our original Ins. PPA, only because we never go to the Dr. for anything. The Dr. I have, who's a really good Dr. does have us come back every 3 months, WHY. He wants us to come back & do blood work checks, am I going to die in that short of a time, NO, these 3 month check up's are always the same, he always says, everything looks good, come back in 3 months. I know people that have lots of medical issues & they go back to their Dr. every 6 months to a yr. So what good will switching to Advantage or any of the other Ins. do us any good, so are these really great deals they want us to go on? Interesting article!

Dan9871 is right on with his description. We have UHC thru the Villages Health and consider it is the best one going anywhere around here. I have always had a advantage plan since I started on Medicare 11 years ago with no payment and no problems. I just had spinal fusion surgery and the bill was about $325,000, I paid maybe 12 or $1400 out of pocket. We have friends that have advantage plans with other companies that give you back 60 or $70 of your part B back as an incentive to sign up, but they go thru hell getting refferals and wait times, we don't have any of that with Villages Health. There very professional, no referrals, no BS.

I forgot to mention UHC has this thing called Passport, so when you travel or are gone for a long period of time you just call them and they transfer your coverage to where ever you are. Obviously it has to be in a bigger Metro. area.

I would suggest getting a Supplement G plan. That way you can go to any doctor in the US that accepts Medicare and there are no co-pays and only a $185 deductible for next year.

We have a Humana PPO plan
 

My wife and I have Humana, a PPO plan. H5216-074 It is a plan that you can get in Sumpter, Marion and Lake counties. We get the $134 taken out of our check and there is no extra cost for the plan at all. It includes Silver Sneakers and our dentist is covered for 2 checkups, xrays and cleanings twice a year, and also fillings, no co pay for dental. We got this plan as we wanted to be covered when we travel the U.S. and when we spend the summers up north. We are covered anyplace in the U.S. that takes Humana, which is a huge network. We previously had an HMO with Wellcare, we were happy with them but we were not covered out of the area except for emergency and urgent care, so that's why we switched. So now even when we are up north for the summer, we are covered in network just like we are covered in network down here.

The passport plan is only covered in certain states and certain areas. If you travel a lot to various areas not sure this would be good. Michigan I know in not covered at all for the passport plan. Checked into this myself before and would not work for us.

I agree it's very confusing but worth spending the time to make the right decision for yourself. I am an RN and have been working in the healthcare system and observing the quality of healthcare services all my life. I also recommend speaking to SHINE. I also did when deciding on a plan when I reached 65. The safest and most comprehensive coverage you can get is with traditional Medicare. There are thousand's of scenarios with different healthcare consequences and everybody has their story. My opinion, after seeing many many many scenarios was that I would never ever choose an Advantage Plan over traditional Medicare. Ask SHINE and also ask anyone else that has been in the healthcare system. I tell people as long as you're healthy and don't really need your insurance, the Advantage plans seem fine but when you start getting health problems your level of care WILL BE DIFFERENT! Trust me, I know whereof I speak! And it's very difficult to switch back to Medicare after you develope problems, they can not accept you or change a higher premium. Ask SHINE.

First, the Advantage plans are really Medicare Part C which is both parts A and B but instead of billing through the Medicare centers they are administered by a private insurance carrier. They may or may not include drug coverage, which you must have. You have to know if the plan is a PPO or HMO. The latter have prescribed doctors (a form of in-network) that you must use to be covered. PPO you can choose your doctor. But, even then, they may have lists of preferred doctors (in-network) who contract for payable rates. SHINE can explain all of this. The Medicare and You book you should receive every year has the information, but there is a lot to read through. Add all the choices for supplement plans (with individual required coverages) and which ones are currently offered to new enrollees, and you have a lot of info to digest. It's enough to give you indigestion!!

Rusty, I was not talking about obtaining out of the area coverage. I was talking about a non-participating doctor being asked to participate and then wait and hope that he would accept the United Healthcare payment . When you're recovering from some operation I don't think you want to be foraging around trying to solicit doctors or PT Clinic into signing up for a HMO plan. If willing, I think they would have done that in the first place. Shouldn't UHC be the ones to do that?

It's not clear to me what you are trying to describe. I don't know how you can protect yourself against assuring you have in network doctors everywhere you go. Like I said if you go to the emergency room you have no idea what doctors will be assigned to you even though the hospital is in network. I had it happen to me. Maybe this will help - The insurance company will pay the non participating doctor their out of network rate. If that doctor wants more than that (not likely) you can negotiate with him/her. This falls under out of network OOP which for 2019 has been reduced to $7500 max. To me I find it difficult to believe one can not find qualified doctors that accept TV UHC. The place is surrounded by them plus the same for specialists. I look at it this way worst case I get burned for $7500. Most negative posts here about TV UHC is because their doctor takes a different insurance. That does not make TV UHC bad. I'm sure there are plans their doctor does not accept. Also all doctors are not required to take medicare. They probably will around here if they want to stay in business.

Rusty, read notes 3 and 12 above that describe what UHC wants you to do if you want to use an out of Network Dr. or Clinic.

What plan are you going with for 2019 ?