Wellness

[KarenQVC]

BTW, Plan F starts at about $150 per month around here.

[glorybe]

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@Carmie wrote:

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@151949 wrote:

This is NOT a discussion of advantage plans vs regular medicare - it is about medicare supplements may go to being HMO/PPO plans. 

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It would not make a bit of sense for Medicare supplements to change to HMO/PPO plans.

Medicare is primary, which means they pay first.  They generally pay 80% of the allowed doctor's tee.  With Medicare you can visit with any doctor of your choosing.

A suppliment pays the 20% of the Medicare allowed fee.  

Why would Medicare save money if your supplement was an HMO/PPO plan?  And why would the government require the supplements to change.... The cost of those plans are paid for by the consumer?

if you could,choose any doctor for Medicare, but your 20% would only be paid if your doctor was in the PPO or HMO network would be CRAZY!

Are you trying to say that Medicare would become. PPO/HMO program, much like the advantage plans?  Advantage plans cost Medicare more then the Traditional plans and the insurance companies are losing money on them too.  

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@CarmieTrue, I am tried of subsidizing Advantage Plans just to keep the expenses down for some people while the rest of us are forced to pay higher prices! We also must buy drug coverage and pay higher prices for drugs, nothing fair about it!

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[glorybe]

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@151949 wrote:

@Sunshine Kate It would be wise to look into the avauilable doctors BEFORE purchasing a plan. Try it out next November.

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@151949 Apparently you do not know that dr's move in and out of PPO status, so it is impossible to predict which ones will stay with that status. In the past, I was advised by the insurance company to call the same day as my appointment to make sure they still were a PPO or I would be stuck with a higher bill!

[KarenQVC]

@glorybe  OMG!

[Moonchilde]

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@KarenQVC wrote:

@glorybe  OMG!

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I learned not to ever trust anything on an ins company's website about the MDs listed. They are literally years out of date.

I also don't completely trust even calling, because if you get a phone person who doesn't know what they're doing or us unknowingly using outdated materials to check....

If I have doubts and want to be sure, I ask to speak to the office insurance person(s).  It's their specific job to know.

[Carmie]

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@KarenQVC wrote:

I think a lot of people with assets have Plan F/C to protect assets from big hits.  These involve in US and foreign travel.  Then there are the extra SNF fees.

The plan has worked for me.  In the last 3 years I have had 105 medical visits.  That doesn't include urgent care, ER, and an emergency operation out of state--plus 2 planned operations in state.

I never had to ask anyone for permision to do anything and I would like to keep it that way.

Believe me, I have no big issues and I haven't even followed up on all referrals or cosmeticish sort of things.  I can't imagine what it must be like for an older person who has real issues to deal with bills.  

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I think people purchase Plans C and F because they are the ONLY supplemental plans that cover the skilled nursing (SNF) coinsurance from days 21 to 100.  This coverage is very important in today's world.  After three days the hospitals will discharge you unless it is medically necessary for you to be there.  You will receive physical therapy, occupational therapy, etc at a SNF

My family member broke her hip last July.  She was in two different SNF's from July to October... And spent a week or two of that time in a hospital.  She used almost all of her SNF days. She would have had to pay for almost 80 days of coinsurance at $157.50 a day.  Thank goodness she had plan F.  She is the same family member that I tried to downgrade to Plan C, but couldn't because the cost would have been higher than Plan F with the late penalties.

From what I have personally seen, most foreign expenses submitted by people on Plan C and F are expenses incurred on a cruise ship.  Medicare does not cover any charges unless they happen on USA soil or water.  Lots of people with limited budgeted funds vacation on a cruise ship occasionally, especially if they live close to a port.

[Carmie]

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@Moonchilde wrote:

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@KarenQVC wrote:

@glorybe  OMG!

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I learned not to ever trust anything on an ins company's website about the MDs listed. They are literally years out of date.

I also don't completely trust even calling, because if you get a phone person who doesn't know what they're doing or us unknowingly using outdated materials to check....

If I have doubts and want to be sure, I ask to speak to the office insurance person(s).  It's their specific job to know.

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Actually, it's the patients job to know if their doctor is in network.  Sometimes a few doctors in the group are in network, but not all of them.  The safest bet is to call your insurance company.  If they give you incorrect information, you can appeal in writing and they are required to pay, per the information given to you.

[Carmie]

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@KarenQVC wrote:

BTW, Plan F starts at about $150 per month around here.

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That seems to be in the ballpark of the average cost.

The OP who was quoted a higher fee of around $800 a month for two people with Medicare and Plan F failed to mention that this very high fee was due to them having Advantage and trying to switch.  They would have to now pay the penalities.

Health insurance is complicated indeed.

[gidgetgh]

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@KarenQVC wrote:

BTW, Plan F starts at about $150 per month around here.

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@I think my husband pays @$180 for his plan F.

[151949]

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@Carmie wrote:

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@KarenQVC wrote:

BTW, Plan F starts at about $150 per month around here.

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That seems to be in the ballpark of the average cost.

The OP who was quoted a higher fee of around $800 a month for two people with Medicare and Plan F failed to mention that this very high fee was due to them having Advantage and trying to switch.  They would have to now pay the penalities.

Health insurance is complicated indeed.

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That $800 included the money taken from our SS check, the premium and the Rx ins plus other fees we would have to pay if we did not have benefits included in our advantage plan like silver sneakers and dental and vision insurance.The premuim for the plan F alone was around $200.  in the end it is over $800 vs $104. Quite a difference. I don't care what other people choose to buy for themselves - no skin off my teeth, but for us this is a way way way better option. When i was in the office at the hospital signing in to get my knee surgery the clerk there told me that about 3/4 of the people she registers have the same insurance I have.