Re: HEALTH PLANS

redstar8 · ‎06-27-2023

Advantage plans are very restrictive. Have to go to "their" list of approved MD's. Not everyone wants this.

Also, depending on what state you live in, Calif., for example, you can change plans ~30 before or ~30 days after you birthday without a penality.

It's a terrible system we have.

CelticCrafter · ‎03-09-2010

@redstar8 wrote:
Advantage plans are very restrictive. Have to go to "their" list of approved MD's. Not everyone wants this.

Also, depending on what state you live in, Calif., for example, you can change plans ~30 before or ~30 days after you birthday without a penality.

It's a terrible system we have.

We have a Supplement plan and unless it becomes cost prohibitive I would never switch to an Advantage plan.

Carmie · ‎10-25-2010

@redstar8 Not all Advantage Plans are restrictive. Some are and some are not.

I first started in health insurance in 1988. It was a lot better before our government got involved.

They make these stupid rules for others, but their insurance is exempt from the same.

Yes, I handled health insurance for our Federal executives. They make sure they have the best and if something isn't covered or paid 100%, they get it paid by exception.

I could tell you some stories if I was able to. HIPAA laws prevents me from spilling the beans.

deepwaterdotter · ‎03-09-2010

@CelticCrafter wrote:
@redstar8 wrote:
Advantage plans are very restrictive. Have to go to "their" list of approved MD's. Not everyone wants this.

Also, depending on what state you live in, Calif., for example, you can change plans ~30 before or ~30 days after you birthday without a penality.

It's a terrible system we have.

We have a Supplement plan and unless it becomes cost prohibitive I would never switch to an Advantage plan.

I feel the same way.

kismet · ‎03-10-2010

I do plan to stay on Medicare but my supplement is expensive and is said to be the best in this area. I've had cancer in the past so it may be harder to find something. I'm fine now. My supplement does cover prescriptions also and most are $10. for a 90 day supply. I'm checking it out now so will know by the fall. I do pay separate for dental with another company and have no eye exams, except for medical eye problems, and no eyeglass coverage. Just wondering what's out there.

Josmad · ‎12-10-2018

@turtle52 wrote:
It really depends what your medical needs are at the time that you select the plan. No one can make that decision for you.

When I selected a supplement for my mother who was in her 90s I took the one that covered everything 100%. Of course it was the most expensive plan but there were no deductibles and copays. She lived to be 101, was in and out of the hospital and had 2 hip replacements. This was an excellent plan for her as she paid nothing for her medical care other than her premiums.

For me I have a plan that covers all but 10% and I have to meet a small deductible. I am in good health and do not have any medical conditions so I am very happy with this plan and I have had it for 6 years. If my health was to change I would consider changing my supplement to meet my needs.

We met with an insurance broker who specializes in Medicare . There was no charge for his services and he helped us to make our decisions. We all have or had United Healthcare and I have been pleased with them. Just know that whatever plan you select can be changed at a later date. Hope this helps!

You may not be able to change it later. Once you are past you initial enrollment period,If you have a Medicare supplemental plan you will need to go through underwriting to change unless you live i a state that allows you to change without underwriting.

judianne · ‎07-09-2014

@Carmie wrote:
@judianne I suggest your husband shop for a different RX plan during the open enrollment period coming up this fall. He might find a better plan.

You can change RX plans every year if you want to with no penalties. He would need a list of what he takes and can compare plans with BCBS and other companies to find what works best.

This would not change or alter his supplemental plan in any way. He could save some money. It doesn't hurt to check around.

l checked out all the other drug plans available for people on the supplement , they all have a $500 dollar deductible . I thought that was interesting , they must of planned it . If your drugs are in the first 2 categories , you don't have to pay the copay , but after covid he got v-fib and needs to take Eloquis , it's not generic and is $700 plus a month .

Josmad · ‎12-10-2018

@Carmie wrote:
Please be aware that you may pay more for coverage through another health insurance carrier than you do now through your husband's employer.

United Health Care and most other insurnce companies will charge you more for their insurance if you do not enroll within six months of first becoming eligible for Medicare. There is a penalty.

Also, you will have to buy a seperate coverage for RX drugs. Drug coverge is not included with a supplement.

If the employer coverge includes dental and or vision...forget about it. You will lose this coverage.

All health insurance companies sell the same Medicare supplemental insurance, but their prices are very different.

example: Jiff peanut butter 10 oz jar. Same product sold in all 50 states, but different prices for same product in every different individual store.

The best supplement is currently available is plan G. After that Plan N.

If you live in a state where providers do not have to accept the Medicare allowance as payment in full, you could be billed for the excess fee.

Example: Surgery cost $10,000. Medicare allows $6000. Medicare pays $4800. Your supplement pays $1200. Both payments equal $6000.

If your doctor does not accept, you will have to pay $4000 out of your own pocket.

If you have Plan G, the overage of $4000 will be covered, if you have Plan N, it will not be covered.

There are other plans available as well. Most do not cover the overage charge.

I personally would think twice about changing insurance. If you are really adamant about it, I would NOT talk to an insurance broker. If you buy their insurance, they will get a commission. You are not new to Medicare and are looking to replace your insurance, not buy something new.

I would call your state's health insurance assistance program ( SHIP). You can find their number by googling SHIP and your state. There is no charge and they do not have any skin in the game.

If you have any questions I can help you with, just ask.

She already has Medicare with a supplemental so she may have to go through underwriting to change her supplemental unless she lives in a state that allows changes without underwriting.

If she did not yet have Medicare she would not have any penalties if she had creditible insurance from an employer.

Your example of excess charges is incorrect. If the provider does not accept assignment the provider can only charge 15% over the allowed amount. So she would not owe $4000.

Josmad · ‎12-10-2018

@Effie54 wrote:
@drizzellla wrote:
Please check with your Doctor's office before you change insurance.companies. Like @conlt said about her Health Care Company. The office manager at our Primary Physican's office said they do not accept any patients that have a well known insurance company.

We have an insurance guy that keeps us updated regarding annual price changes In fact I just got an email about changing to one company. I would save $600 a year. But after calling the Primary Physican's office, the office manager said she never heard of them handling health insurance. The company is just getting into the health insurance business. This causes me to rethink about changing.

Please talk to your Doctor's office and an insurance person who handles health insurance. It is too important a decision not to do some homework.

Can you tell us what insurance company your office doesn't accept? It's good to know ahead of time what the best insurance carrier is and which to avoid.

If a provider accepts Medicare they must accept your Medicare Supplemental plan.

Carmie · ‎10-25-2010

@Josmad wrote:
@Carmie wrote:
Please be aware that you may pay more for coverage through another health insurance carrier than you do now through your husband's employer.

United Health Care and most other insurnce companies will charge you more for their insurance if you do not enroll within six months of first becoming eligible for Medicare. There is a penalty.

Also, you will have to buy a seperate coverage for RX drugs. Drug coverge is not included with a supplement.

If the employer coverge includes dental and or vision...forget about it. You will lose this coverage.

All health insurance companies sell the same Medicare supplemental insurance, but their prices are very different.

example: Jiff peanut butter 10 oz jar. Same product sold in all 50 states, but different prices for same product in every different individual store.

The best supplement is currently available is plan G. After that Plan N.

If you live in a state where providers do not have to accept the Medicare allowance as payment in full, you could be billed for the excess fee.

Example: Surgery cost $10,000. Medicare allows $6000. Medicare pays $4800. Your supplement pays $1200. Both payments equal $6000.

If your doctor does not accept, you will have to pay $4000 out of your own pocket.

If you have Plan G, the overage of $4000 will be covered, if you have Plan N, it will not be covered.

There are other plans available as well. Most do not cover the overage charge.

I personally would think twice about changing insurance. If you are really adamant about it, I would NOT talk to an insurance broker. If you buy their insurance, they will get a commission. You are not new to Medicare and are looking to replace your insurance, not buy something new.

I would call your state's health insurance assistance program ( SHIP). You can find their number by googling SHIP and your state. There is no charge and they do not have any skin in the game.

If you have any questions I can help you with, just ask.
She already has Medicare with a supplemental so she may have to go through underwriting to change her supplemental unless she lives in a state that allows changes without underwriting.
If she did not yet have Medicare she would not have any penalties if she had creditible insurance from an employer.
Your example of excess charges is incorrect. If the provider does not accept assignment the provider can only charge 15% over the allowed amount. So she would not owe $4000.

Thank you for updating me on the excess fee charge. At one time, the providers could bill the total amount. I am happy that has been changed.

She said she already has MEDICARE. I know from experience that UNITED HEALTH Care will charge you a penality to change coverage outside of the six month window.

I tried to help a friend save money by downgrading her supplement from with UHC PLAN H to UHC PLAN C. They wanted $60 a month more to downgrade charging the penality. In addition, their rep talked her into purchasing Plan H when she was 65 which was not the best coverage for a person who lives in PA. There was no need to have Plan H in a state where the excess fee cannot be billed. The Medicare B deductible covered under PLAN C would have been the better choice and cheaper

So many brokers only look out for themselves and not their customers.