Medicare supplemental insurance question
 

Hi to all you good people out there. Having a real delimmea rite now and alot of stress. At the moment my husband and I have Preferred care insurance in the villages. It was nice because the premiums were offset the past two years..which cant complain about that. D o not know what is going to happen to medicare advantage programs in 2014 via obamacare..however, we just found out ..we dont even have access anymore to a retina specialist or othmalgists in our insurance provider directory. We were told after trying to make an appointment today with an eye doctor on preferred care, that our zip code is not accepted, sumter county anymore..3 doctors already called that said that...we were shocked and got the runaround by preferred care.
now we are told..WE ARE ASSIGNED TO ONE AND ONLY ONE EYE DOCTOR IN ALL OF FLORIDA..and if they deem it necessary to see a retina specialist which they do not have on staff, they go from there. my husband is a diabetic and of course that concerned us.
We definitely will probably make a switch next year to another 'insurance' but its mind boggeling trying to figure this out.
DOES ANYONE READING THIS HAVE A MEDICARE -SUPPLEMENT- AND IF SO HOW ARE THE PREMIUMS AND COVERAGE? PLEASE EMAIL ME AT
flowerpower55@gmail.com
SO VERY GRATEFUL FOR ANY IMPUT.
WENT TO AARRP ONLINE..AND VERY BRIEF SUMMERY OF A FEW OF THEIR PLANS..UNITED HEALTHCARE ETC. IS THERE ANYONE IN THE VILLAGES TO SPEAK TO ..THAT CAN EXPLAIN THESE SUPPLEMENTAL PLANS
THANK YOU THANK YOU THANK YOU....
flowerpower55@gmail.com (marlene)

Go,to The Preferred Care Partners office in Sumpter Landing and talk with them.. Something doesn't sound right. I have Glaucoma and go to MidFlorida Eye.
http://www.midfloridaeye.com/index.html.

I hope you can work it out with PCP as you certainly save some money but wih heart and diabetes problems we found the doctor choice to be unacceptable for us. If you do have to go with a regular supplement I highly recommend AARPs United Health Care plan F. We've had it or years and never had a problem. It runs about $175 each per month.

I have worked in Physician's offices for over 30 year and still work in a Ortho office in TV and I always knew when the time came to get Medicare and secondary ins for my husband ( as he goes on it in Sept) it was going to be AARP. All the Medicare advantage plans have too many strings attached, yes they are cheap but at our age I don't want to be told who and where we can go for treatment. AARP has several plans (plan F IS the most popular and will run about 167 a month but you will probably never have a balance from anything or any Dr. And can go anywhere in the Country to receive the best care if you ever need it.

I agree and have the AARP 'F' Plan which is the cadillac of all the plans..

My husband has PCP and was just denied a follow up visit by Mid Florida, they told him they no longer take PCP......we will check back with them.

I will call Preferred Care Partners in Sumter tomorrow. (Easier to talk with them than main number ). I have a follow-up with Mid Florida end of July. Wasn't anticipating any problems, but best to call.

We have AARP Plan "J" which is the best of the best, but is no longer available - thankfully we had bought into it right at the beginning so we are grand fathered. Take the best United Health Care plan you can afford. Neither one of us had ever been sick, about two years after moving here the other half was diagnosed with rare form of cancer and I had a major kidney problem which could only be treated at Mayo.

Give up other things, but get the best health care you can afford. Ours costs us about $350 for two per month, then factor in your Medicare payment off your SS. Expensive stuff, but so worth it when you need it.

Do any of these policys include RX Drugs? If not, how much extra is this?

Oh good grief!!! Two years ago when we signed up with PCP Mid-Florida Eye was "with" the network BUT a few months later I wanted to make an app't and they said they no longer were with PCP. Now fast-forward to this year (2013)...we were told they're back with PCP! What exactly "gives" with this organization (Mid-Florida Eye)???

I guess I'll contact the PCP office myself to find out the true state of affairs!!!
Oh...the one thing I was told back when was we need to see an optometrist first then we'll be referred to Mid-Florida Eye's specialists...so maybe that's the case here. The thing about zip-codes sounds complicated to me!!

This is a sad testimony to the confusion of health care.

Just wait until the rest of the governments health care laws go into effect.

Also remember that what ever you have today, like it or not, it is the very best you will have at any point going forward.......ditto for office waits...what is not going to be covered surprises..... and just wait for the cost increases.

And since most people including administrators of providers, we won't know anything until we see the price increase.

Tis only the beginning.

btk

Here is the way I understand the situation. For an eye exam one must see an in network optomitrist first and get a referral. Mid Florida's optomitrists are NOT in their network. If you have an established diagnosis ie glaucoma, you do not need a referral and may go directly to the Mid Florida Eye Ophthalmologist.

All of the Plan F s I have looked at so far do NOT include prescription drug coverage. That extra coverage runs about $40 per month. Again, you pay nothing after that, as long as the drug is covered by Medicare.

OK so Plan F would be $175/ month, RX drug coverage would be $40/ momth.
Plus $99 is deducted from your SS per momth.

That comes to $314 per month per person or $628 per couple.

I'm sure Plan F is great if the money is there

For those couples unable to spend this much per month, Preferred Care Partners is another option.

I absolutely agree, but as pointed out, it has to be affordable. I too was grandfathered into Plan J from AARP United HealthCare; this includes a couple of benefits that Plan F doesn't, but they're very specific benefits that I've never used and in truth don't even remember what they are. (Do you remember them, Madelaine Amee? If so, please send me a PM.) I should mention too, as I did in another thread, that Plan F is Plan F; they're all identical no matter what insurance company is offering it, and the AARP plan has the absolute lowest premium, at least in FL.


Yes, none of the Medicare Supplement plans include prescription drug coverage, which require a separate enrollment. I have yet to find one of these that I'm satisfied with; I've changed plans virtually every single year! To me it's no surprise that these plans are NOT supportive of senior consumers but rather of the insurance and pharmaceutical industries.... If anyone has any suggestion for what's good in these plans, please post it. Thanks!

I respectfully disagree ...
 

I respectfully disagree, at least to a great extent. The "beginning" was a good quarter century ago or even a couple years more than that. There was a climate in our country that threw consumers and working Americans under the bus in behalf of whatever you want to call it: "big business," "multinational corporations," "the bottom line," "extraordinary CEO salaries and benefits packages," and so forth. At the risk of being off-topic for one statement, that was the time when corporations were able to begin shipping decent-paying American jobs to third-world countries, along with the death knell of American manufacturing industries.

As far as medical care was concerned, "big business" in the form of the insurance and pharmaceutical industries were given more control, taking it from the relationship between doctors and their patients. Soon an insurance clerk could tell a doctor what services he or she could--or could not--provide for patients. The focus became "the bottom line," less for the doctor and more for "big business." (I realize this is an ovesimplification.) As the well-paying jobs disappeared overseas (the jobs that invariably included health insurance coverage), the service businesses, which by their nature were nowhere near as profitable, did not offer health insurance coverage and created huge numbers of low-income workers, often at minimum wage or barely above, who now use hospital ERs for their medical care. One need only to refer to another thread about the long waits in ERs to understand this better.

When Medicare Part D was created in the first decade of this century, I looked at it and saw it as a travesty for senior consumers and a boon to the insurance and pharmaceutical industries. The government at that time went so far as to pass a law prohibiting Americans from buying their prescription drugs far cheaper in Canada (or from Canadian sources). And why were they cheaper in Canada, especially that they were the identical drugs? Because Canada required the pharmaceutical companies to negotiate prices based on bulk purchase, while in the U.S. the full costs had to be borne by seniors, in order to maximize profits for the companies, and who had also to contend with deductibles and "doughnut holes" even as drug prices rose!

Way back when, living in New York State, I had to have a radical surgery that was so serious that I had to be flown to another state for it to be done. My insurance company, Empire Blue Cross Blue Shield of New York State, covered about 20 percent of the cost, saying that that was their "reasonable and customary" payment for this surgery. Thankfully, NYS had a government that was supportive of its citizenry; I asked the NYS Insurance Department to demand of Empire how it had arrived at this "reasonable and customary" figure, since the surgery had never been performed in NYS! Thanks to this governmental agency's support, Empire was required to cover considerably more of its cost!

And it has continued to worsen. I'm in the care of a doctor since he began practice, and he's ready to retire, so I know him well. First, I asked him why out of the clear blue he had "sold his soul" to some major medical holding corporation. His answer? "The way things are going, we have no power anymore at all; we can no longer decide what's best for our patients. The corporation, much as we dislike it, is what medical care has become." Second, he confided to me that he had dissuaded his daughter from going to medical school, which had been a lifelong dream of hers. However, she understood, seeing what her Dad was going through, and instead is now in her second year of veterinary school and is happy with this second choice. But this means the loss of someone who would likely have become an excellent physician. Sad.

OK, I'm getting off my soap box....

You have identified some of the fundamental inequalities which have been part and parcel of health care in the most prosperous nation on earth.

My glass is half full - but I do get frustrated when I read posts from folks who are certain the Affordable Care Act is not an improvement.

Give it a chance. There will be tweaking. Just today the deadline for the small business insurance mandate was extended to 2015. I want to change insurance because my health situation has changed. I'm guaranteed I can do that. I'd woud have been turned down flat by every company in the past. Coverage will be extended to millions who otherwise end up in emergency rooms we pay for. The fraud investigation rules have changed and hundreds of millions have already been saved by catching crooks before they can raid the cookie jar. Etc, etc. etc.

Give it a chance.

You have identified some of the fundamental inequalities which have been part and parcel of health care in the most prosperous nation on earth.

My glass is half full - but I do get frustrated when I read posts from folks who are certain the Affordable Care Act is not an improvement.

Give it a chance. There will be tweaking. Just today the deadline for the small business insurance mandate was extended to 2015. I want to change insurance because my health situation has changed. I'm guaranteed I can do that. I'd woud have been turned down flat by every company in the past. Coverage will be extended to millions who otherwise end up in emergency rooms we pay for. The fraud investigation rules have changed and hundreds of millions have already been saved by catching crooks before they can raid the cookie jar. Etc, etc. etc.

Give it a chance.

I could not agree more!!!
 

Thank you; I could not agree more!!!

You make three significant points that I have emphasized, the first and third in bold and the second underscored (just to differentiate them.

1. Look at the threads about people agonizing about which type of coverage to take; the new plan will eliminate the ability of insurance companies, who now control who gets covered and who doesn't, to reject someone based on past medical history.

2. I still find it hard to believe that there are those who object to nearly 50 million of our fellow citizens having easier access to health care than flooding our hospital's emergency rooms, which we all pay for over the long haul anyway.

3. The present level of fraud, which is outrageous, did not exist before the insurance industry controlled medical care. Some, yes, I'm sure, but nothing like now. My personal disappointment with the Affordable Health Care Act is that it did NOT eliminate the insurance industry from the equation, but that's the American system of lobbying.... But this act WILL be able to eliminate (hopefully) much of the fraud that is rampant in the present system.

Yes, I agree: Give it a chance!

P.S. When you wrote "I do get frustrated when I read posts from folks who are certain the Affordable Care Act is not an improvement," I suspect--though I could be wrong--and would be happy to be wrong--that these folks who object to the Affordable Health Care Act have reasons that are not directly related to health care itself....

I don't understand.

If "big business," "multinational corporations," "the bottom line," "extraordinary CEO salaries and benefits packages" are the problem, then why is United Healthcare--marketing its policies thru AARP and paying AARP commissions "like an insurance agent"--NOT a "Big Business" problem in the Medicare system people are grappling with here?

"UnitedHealth Group Incorporated is a diversified managed health care company headquartered in Minnetonka, Minnesota, U.S. It is No. 17 on Fortune magazines top 500 companies in the United States. UnitedHealth Group offers a spectrum of products and services through two operating businesses: United Healthcare and Optum.

Through its family of subsidiaries and divisions, UnitedHealth Group serves approximately 70 million individuals nationwide. In 2011, the company posted a net earnings of $5.142 billion.

UnitedHealth Group is the parent of UnitedHealthcare, the largest single health carrier in the United States. It was created in 1977, as United HealthCare Corporation (it was renamed in 1998), but traces its origin to a firm it acquired in 1977, Charter Med Incorporated, which was founded in 1974.
In 1979, it introduced the first network-based health plan for seniors. In 1984, it became a publicly traded company."
----------

Now, I don't have an MBA, and I'm not a CEO nor a CFO, but it sure looks to me like United Healthcare is "Big Business" and is surely focused on "the bottom line"......and its CEO gets "extraordinary salaries, benefits and stock options":

"Stephen J. Hemsley (born 1952) has been CEO of UnitedHealth Group Inc since 2006. Before joining the company in 1997, he had a career at Arthur Andersen, where he was Managing Partner and Chief Financial Officer.

According to bizjournals.com the country's highest-paid CEO, Stephen Hemsley, made $101.96 million in 2010. In 2011 he was named the highest paid CEO by Forbes following a large gain in the value of his stock ownership. In late 2011, Hemsley's most recent annual compensation was estimated by Forbes at $48.8 million."
_____

AARP
"Approximately seven million people have AARP branded health insurance, including drug coverage and Medigap, as of April 2007 and AARP earns more income from selling insurance to members than it does from membership dues.

In 2008, AARP plans to begin offering several new health insurance products: an HMO for Medicare recipients, in partnership with UnitedHealth Group; and a PPO and "a high-deductible insurance policy that could be used with a health savings account" to people aged 50–64, in partnership with Aetna. AARP will likely become the largest source of health insurance for Medicare recipients, and AARP estimates the new products will increase its health insurance customers to 14 million by 2014.

AARP is not an insurer and does not pay insurance claims. Instead, AARP allows its name to be used by insurance companies in the sale of insurance products, for which it is paid a commission like an insurance agent."
______

UnitedHealth Group - Wikipedia, the free encyclopedia
Stephen J. Hemsley - Wikipedia, the free encyclopedia
AARP - Wikipedia, the free encyclopedia

First, as I said, what I wrote as an oversimplification.

Second, AARP and United HealthCare are taking advantage of the present structure of medical coverage in the U.S. Why shouldn't they? As I said, under ideal circumstances I would have preferred to see the huge insurance industry, which you've cited, out of health care, but lobbying certainly prevented this from happening.

And third, if profit were the sole motivator behind AARP's and United HealthCare's involvement in Medicare Supplement and Part D Prescription Drug plans, why do seniors flock to them? Could it be because they have the lowest premiums? I'm not intimating that they're in business to be a "public service," but when I had a choice of identical plans some years ago, the premium for my Medicare Supplement plan was (and still is) about $100/month LESS than the identical plan offered by Mutual of Omaha, which was the plan sponsored by my former employer! In other words, although AARP/United HealthCare is indeed profitable, could they have been MORE profitable? Absolutely! Again I'm oversimplifying, but they could have made their premiums, say, $50 higher than other plans and still have had their same following, but they chose not to.

Many years ago, stock market guru Peter Lynch, when asked how he came to select the stocks he did (and was incredibly successful at it), explained that while he did his homework, he also looked at everyday living and everyday products. As an example, he said that his wife used L'Eggs Panty Hose virtually on a daily basis, and this is how he became aware of the company. Other companies manufactured panty hose, but after investigating the "health" structure of the company that manufactured the product his wife used and was satisfied with what he found, he named it a company worth investing in based on practical, everyday experience.

To my way of thinking, no matter what their profit margin is, saving me $100/month is pretty sensible on an everyday basis....

Last year we were told by Mid Fla that PCP dropped them(not visa versa) I think because they have so many patients and PCP did not want to pay for all of them.

You are correct. Full coverage for a couple would be over $600 per month. That is a lot, unless you have a serious illness which results in thousands of dollars of annual medical bills. But there are also slightly scaled down plans, like AARP's Plan N. It costs about $100 per month (saving a couple $150 in monthly premiums) and the out-of-pocket costs are basically small co-pays.

Interesting. I called both PCP abd Mid Fl Eye this morning. My followup end of the month (July) is still scheduled.

Last year when Mid Fl was dropped by PCP we were told that follow-up was accepted but not a new problem.

Maybe that's what happened.

Lange and Mid FL. both dropped PCP because they did not pay their bills. Lange did one of my husband's cataract surgeries and a week before the second surgery they called him and said they were in litigation with PCP for non payment. We called PCP and after a month they sent him to Mid Fl..he had the surgery and then when his follow up appt. was a week away, we received a letter stating that they no longer accepted PCP for the same reason.

The state of Florida has a department that helps individuals understand Medicare. Unfortunately I do not remember its name. I would do a search on the internet to see what assistance Fl might offer. I think the department is set up on a county by county basis so you could meet in person.

If you had Preferred Care Partners...they'll be no longer in 2014. "IF" you want to go to the USF clinics here you will need the United Health Care policies...though they will see patients with other insurances if it's not an HMO or a PPO. I followed my practioner to USF and don't want to change physicians. Using UHC you will see docs within network. That list isn't public yet. IF I wasn't as picky as I'm being, I'd change to Freedom Health.

To ALL...Remember that when you go with any Advantage Plan to save money that you are limiting your choices of doctors and hospitals . They also can change at any time.

As we get older it is sometimes best to go with a Medigap plan (also more $$$) in order to go anywhere you wish w/o restrictions.

Best of Luck to you in your choice of plans!