Medicare Supplement - Do Networks Apply?
 

I am not yet eligible for Medicare, but will be early next year. Currently, my BCBS (FL Blue) individual Silver PPO medical insurance only covers specialists within the BCBS in-network list, so I am quite limited in my choices, and don't have my preferred specialist in the network. If I choose BCBS or any other supplement with original Medicare, am I understanding that as long as the specialist accepts original Medicare (which most do), that there is no more "in-network" to consider with a BCBS supplement? This would definitely widen the specialists I could see. I am specifically asking about supplements here, not advantage plans.

You need to contact SHINE ,
SHINE - Home,
as they will provide unbiased information that you need. They have on site meetings in TV at several rec centers. Very helpful people, and they saved us from making a very big mistake.

Yes, if you have original Medicare, the Medicare supplement will cover you as long as the provider accepts original Medicare. The supplement is basically a piggyback plan for original medicare. There are no networks, like Medicare Advantage.

Looking forward to when I turn 65, and being able to get on traditional Medicare with a supplement, so I can get away from “networks” and having to seek out referrals to see a specialist.

Be careful with terminology, I have heard the term supplement referred to both as Medigap plans as well as Advantage plans. Be sure you avoid Advantage plans and focus in on Medigap plans if you want to be sure to avoid both networks and referrals. Advantage plans can appear to be both cheaper and to offer different types of fringe benefits, but we will all eventually all need some expensive medical care and not want to be constrained by networks, not have to seek out referrals, have to worry about what is covered, and have to sort through copay and deductible bills for our health care. In the long run, traditional Medicare with a Medigap and part D prescription policy are the best way to go. Best of luck with your decision.

Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now

While I agree with the above, Supplements come at a price. My United Health Care Supplement Plan N comes at $185 per month and my Part D drug plan is $52/month. My former employer pays $1000 per year toward this expense.
Some folks can live within the networks and perhaps count the above expense as their savings.

For a family of two, having a supplement for two, that is a $4000 expense. That can mean a lot to some who are willing to contend with the network issue.

I don't know all the answers to your questions, but I wonder about some of your assumptions . . . Couple of years ago I was at an appointment with an ophthalmologist through my Advantage plan. She said she was retiring in a few months, and moving to Phoenix. She complained that most of the doctors in that area were full, and not accepting new patients. So, this belief, that you can see any MD who accepts original Medicare, may not be accurate. And in my experience, almost any medical professional has a full schedule for several weeks out or more. A primary doctor can get you in faster perhaps if they believe you need to be seen sooner. If my beliefs are accurate and widespread, your goals and means may not be realistic.

There are really 2 choices in the Medicare world.

"Managed healthcare", where a provider manages your healthcare. An insurance company, who is in business to make a profit, is making your healthcare decisions.

Or "Self managed", where you yourself, directs your healthcare to your benefit.

It's a very simple equation. Who should be in charge of one's healthcare? A corporate entity, whose goal is to make profits or one's self, who's goal is to stay healthy and live a long and prosperous life?

Or, we could look it at another way. Name ONE "advantage" a Medicare Advantage Plan offers over a Medicare Supplemental plan, that isn't related to costs or "freebies".

It's a no brainer, unless financial constraints force you into a Medicare Advantage plan.

Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

You are right. Big advantage. Can visit most doctors nationwide & if you need a specialist, you can see the one you want, where you want.

I don't consider that an advantage at all. But to each his own.

55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

Absolutely 10000% true and well said. And that's from my perspective of providing primary care for 35 years.

Sorry, but I'm forced to disagree, and I probably know a bit more on the subject

The "insurance company" is NEVER "managing " your care under an advantage plan, it is primary care physician. Are there networks and limitations---yes, but it's easy to get an exception. In 35 years, not a single patient of mine was denied anything they needed anywhere they needed it. All that has to happen is that your primary care physician calls the medical director of the insurance plan. While I had a 100% success rate, I'm sure overall that rate is over 95% as long as the proper effort is put in. Remember, while that medical director is "safeguarding" the insurance co. $$$, they want absolutely no part in any decision that might adversely affect outcomes. Simply not worth the hassle for them, and the primary care physician will usually get an approval in 2 minutes.

As far as the second choice---"direct you own medical care", I cannot emphasize how bad an idea that is----kind of like deciding to build your own home nuclear reactor for cheap energy. Most often, it will blow up in your face. That is unless anyone thinks they can match 11+ years of medical education and years of experience by "googling" something. And surprisingly, there is a whole cadre of idiots who think they can do just that.