Talk of The Villages Florida

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-   The Villages, Florida, General Discussion (https://www.talkofthevillages.com/forums/villages-florida-general-discussion-73/)
-   -   Medicare advice (https://www.talkofthevillages.com/forums/villages-florida-general-discussion-73/medicare-advice-326774/)

LG999 11-28-2021 08:43 AM

I have used a medicare broker. Brokers are free to you. You tell the broker your criterion, names of all your drs, health facilities & hospitals You want covered and are presented with plans to select from. It is so much less laborious. Two of my requirements are 1) no referrals required 2) must have free gym membership. Yours will be different.

Marine1974 11-28-2021 08:47 AM

Medicare will help you select a supplemental plan , call them . All the plans are published on a web site you can review .
Medicare charges me $148 a month . Supplemental from UHC plan G has a $208 yearly deductible for $138 a month . Medicare is going up to $170 a month next year . For $308 a month you have peace of mind your not going to go broke paying for healthcare costs . This does not include dental . Will pay
eye care if you have the beginning of cataracts . Why did you wait to start investigating health insurance?

Heyitsrick 11-28-2021 08:53 AM

My late mom was a Villages resident who got talked into switching from a "Medigap" (supplemental) plan to the Villages Medicare Advantage (aka "MA") plan. One of her doctors told her that was the only insurance they would take.

It was quite costly in the end. This plan would only cover in-patient hospital stays after the 3rd day. She had several in-patient hospital stays the year she had this MA plan. We had to essentially beg the Villages hospital to absorb her bills, as they were thousands of dollars.

There were rules about getting OUT of MA plans if you've been in one longer than a year. She couldn't switch back to a traditional medicare supplemental plan without going through a health exam - and if they even accepted her as a customer, her monthly supplemental premium would have been exorbitant. In other words, she no longer had "guaranteed acceptance" (no health exam) for supplemental coverage. The only way she was able to keep guaranteed acceptance and switch out of MA was to move out of the Villages to Crystal River - outside the Villages MA plan's coverage area.

So, good move trying to get off of MA, and you shouldn't have any problem switching since you just started on MA in October.

I would recommend you look at / investigate Medicare Supplemental Plan "G". Plan "F" is no longer available to new patients, but Plan "G" is, and covers everything Plan F did.

Good luck.

Rzepecki 11-28-2021 09:18 AM

Quote:

Originally Posted by villagetinker (Post 2034334)
OP, contact SHINE, SHINE - Home, or (1-800-963-5337), for UNBIASED health care information. There are typically local meetings that you can talk to the reps directly. These people do NOT sell any insurance they will work with you to understand the various options.
Medicare and supplemental is the gold standard (IMHO), the part C ads for Medicare ADVANTAGE plans are NOT insurance plans these are managed care plans, you need to understand the difference. There can be significant limitations with these plans. SHINE will provide a lot of this info.

Another vote for SHINE! They meet at the local rec ctrs on a first come, first served basis. They won’t steer you to one insurance or the other, but will give you all the info you need to make a decision. Really helped us when we were in your position.

capecoralbill 11-28-2021 09:26 AM

Quote:

Originally Posted by ladygolfer123 (Post 2034527)
You can call United Medicare Advisors @ 855-390-9791 and agents there are willing to advise you (not sell) what is available to you in your area. Was the easiest and best call I ever made. You are the one to make the decision. They can tell you price per month and even sign you up right then.

Get it in writing, these agents are SALESMEN, their salaries, (commissions) are paid for by UHC.

Carla B 11-28-2021 09:48 AM

It's easier to understand Medicare if you know that there are two basic systems: 1) Original or Traditional Medicare, and 2) Medicare Advantage.

1) Original or Traditional Medicare plans are also called Supplemental or Medigap plans. In this scheme Medicare pays the doctor or provider 80% of what Medicare decides is a reasonable cost for the service you receive (not what the doctor bills). Medigap plans then pay the provider the remaining 20% of that "reasonable" cost. You can use any provider that accepts Medicare patients. This system is administered by the government.

2) Medicare Advantage plans are run by insurance companies. The gov't hands over the Medicare premium that you must pay to the insurance company and the company decides on the benefits they will offer their subscribers. The company contracts with certain providers that agree to offer services at an agreed-upon rate. You must use a provider that has a contract with that insurance company.

There are different levels of benefits offered within Original (prescribed by law) or Advantage (promoted) programs, but all plans are one of two basic types. The advertisements in the mail and on TV are all Advantage plans.

Roron123 11-28-2021 09:50 AM

Personally I prefer straight Medicare with a supplemental insurance! You can go “anywhere and to any Doctor or hospital of your choice and you will be covered 100%. If you prefer an Advantage plan make sure it is a PPO NOT an HMO (you will have limited choices of Drs, Hospitals etc.) Aetna, UHC and Blue Cross would be the better choices but PPO. Check the plan you pick to see if all your doctors etc are on the plan you want to pick! Good Luck

Westie Man 11-28-2021 10:46 AM

Just do what Martha says
 
she knows what she's talking about :1rotfl:

kenoc7 11-28-2021 10:58 AM

Quote:

Originally Posted by retiredguy123 (Post 2034349)
Health care is expensive because the patient has little or no requirement to pay any of the cost of treatment. The only way to reduce the cost is to require patients to participate in the cost of treatment.

Health care is expensive because 1. the high costs added by private insurance companies; 2. the ridiculously high fees charged by hospitals and doctors in the USA, and 3. you don't have public health care (unlike every other developed country)

bumpa 11-28-2021 11:19 AM

The plan you select should match up with your current and near future medical condition. Since plans are selectable every year you can continue to match your plan to your medical needs. If you're very healthy your plan selection can be a lower cost limited benefit plan like an Advantage HMO. If you have serious health issues than opt for a more comprehensive plan. Bear in mind that all of the supplement plans ex. A,B,C,E,F,G,etc are all the same but can be priced differently by various insurance companies. Don't buy on price, buy the plan features.

beccaboo** 11-28-2021 12:03 PM

Medicare Advice
 
Quote:

Originally Posted by Rainger99 (Post 2034313)
I just started Medicare on October 1 - and I am baffled by the number of plans and options available. And every time I turn on television, I am inundated with commercials for Medicare plans. I would be interested in any advice on which plans to sign up for and perhaps more importantly - which plans to stay away from. I currently have United Healthcare The Villages Advantage (HMO). The enrollment period ends on December 7 so I have time to change plans. I am also surprised at how expensive "free healthcare" is. I am paying more for healthcare now that I was when I was working.

It is critical to understand that the timeframe of the first 6 months you go onto Medicare is a guaranteed issue. This means that you cannot be denied coverage or charged more regardless of your health status or any pre-existing conditions. Therefore, it is very important to know whether you want traditional Medicare or an Advantage Plan. After the guaranteed issue period, it can be quite difficult for some to secure a supplemental plan, should you wish to switch back to traditional Medicare.

tombpot 11-28-2021 12:06 PM

Just get traditional Medicare with plan G supplement from AARP. I’m going out State to see a specialist, no referral needed, and I can choose any Doctor that takes Medicare which most of them do. If you have an Advantage Plan the insurance company will manage your care not you. If you try and change to traditional Medicare later on you will pay more, and they will pre existing condition you, because you are out of your enrollment period.

kathyspear 11-28-2021 12:24 PM

Quote:

Originally Posted by Carla B (Post 2034598)
2) The gov't hands over the Medicare premium that you must pay to the insurance company and the company decides on the benefits they will offer their subscribers.

FWIW: I assumed that if you had an Advantage plan the govt. gave the ins. co. your ~$150 monthly premium and I couldn't imagine how the ins. co. could make money on the deal. But I read the other day that the govt. actually gives them $750 to $1500 per month, depending on where you live.

kathy

retiredguy123 11-28-2021 12:37 PM

Quote:

Originally Posted by kathyspear (Post 2034681)
FWIW: I assumed that if you had an Advantage plan the govt. gave the ins. co. your ~$150 monthly premium and I couldn't imagine how the ins. co. could make money on the deal. But I read the other day that the govt. actually gives them $750 to $1500 per month, depending on where you live.

kathy

Another way they make money is by denying fraudulent claims that would be routinely approved by original Medicare. Original Medicare claims are sent directly to the Government, many of which are fraudulent, but the Government just pays them. They don't care if they waste taxpayer money. But, Medicare Advantage claims are sent to the private insurance company who has a profit motive, and they will do what they can to ensure the claims are valid, and to create other efficiencies into their system to save money. That is why some medical providers are removed from their networks.

2BNTV 11-28-2021 01:07 PM

Another strong vote for SHINE!!!

The last time I saw it in the paper was Nov 30th at 9 AM, Lake Miona RC.

Dec 1st at Eisenhower RC. Call 800.963.5337.

They are extremely knowledgeable of all plans and don't have an ax to grind in whatever you select. They have been very helpful to me in the past.

I would go immediately because the deadline is December 7th and only you know what health concerns you have and what plan best suits your needs.

Good luck!


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