Wellness

[judianne]

l have a BCBS Advantage plan . lt's $97 a month . Pays all my meds through a mail order service , no copayment on 8 drugs and $20 for 3 months of one drug .l take 7 prescriptions . They pay up to $1500 on dental including cleaning fillings and crowns . They pay for vision checkups and $150 on glasses .  All my regular primary Dr appointments have no copay .

Last year , 2022 , l had 3 surgeries , was hospitalized for 8 days once and 5 days another , as well as a ER visit . l had home nursing care for over two months . My bills were very minimal . $200 for each hospital stay , and that included everything , surgery, anesthesia,hospital room , PT , l had an infection in a knee replacement , and was referred to a specialist at this hospital , so they took out the infected parts and after a couple months they put in a new replacement . All of it covered except for the deductible which ended up being $690 dollars total

. Midway between the two big surgeries , l had to go back to the Operating Room, to put the spacer back in place after it moved . That was the same $200 dollars as the big surgeries and's long hospital stays , because l had to be admitted , even though l didn't stay overnight .

 l have been very pleased with my Advantage plan , l have had it for 6 years . My husband chose a supplement plan , he pays $276 a month and also $38 a month for his drug plan .So including the medicare part B cost , he is paying over $400 a month for his insurance plans .  He has no vision or dental benefits and his drug copays are really high . After the $500 deductible on drugs , he still has 1 drug costs $105 a month , another is $48 a month , one is $92 for 3 months , He takes 11 prescriptions , He has no copayment or deductible for his Hospital or Dr visits . He has a kidney transplant and prefers this Medicare plan , it's also BCBS . 

[Sweet Kitties]

I realized that my first post may not have been of help to you. A medicare suppliment insurance is best for my husband & I, but for some people an advantage plan is the best option. There is a youtube channel that would be a lot of help to you. It's called "Medicare Specialist--ABT Insurance." I highly recommend following her site. She's an independent insurance agent who puts out many videos that would answer your questions. We can all give you our antidotal experiences & advice, but she is a better independent source.  Hope this helps.

[Carmie]

@drizzellla  That's good advice for those who don't have Medicare  as their primary insurance.

When you have Medicare, that's one less thing to worry about.  If your doctor accepts Medicare, that's all you need to know.  It doesn't matter what type or who your supplemental insurance is with.

[Mimi NY]

The past few months we were in the same predicament in deciding if we would join what the City of NY was offering exclusively for City of NY Medicare eligible retirees and their eligible dependents starting in September .It is the Aetna Medicare Advantage PPO Plan.My husband once again leaves it to me to decide, I hope I made the right choice in going for the new plan,was wondering if  any others were in the same predicament in joining what NYC was offering their retirees.

My main  thought is too stay healthy so you don't have to use your plan,but if you do hope it's what they are saying  it is.

[Carmie]

@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.

[Mindy D]

@Carmie I would like to know which Advantage Plan you have that pays 100% for everything. Do you pay zero for the first days of hospitalizations too? Do they pay 100% for up to 100 days in a skilled nursing facility or is there a copay after a certain amount of days? I'm looking at plans. I know they vary by location. Thanks for all the helpful tips you've provided about insurance. 

[Carmie]

My Advantage plan is part of my retirement package from my employer.  I retired from a health insurance company, so it it is not sold to the public. I am very fortunate.

It pays up to 100 days at 100% in a SNF. It pays 100% for everything... all hospitals, doctors, RX, dental.. except for implants and cosmetic procedures and hearing aids...allowance is $6000 for them and $300 for glasses.

I pay zero out of my pocket for medically necessary covered items. 

You are smart looking ahead for SNF coverage.  Medicare and Advantage Plans mostly pay 100% for the first 21 days.  After that, it can get expensive with copays for the next 80 days.

Not many people need more than 21 day of rehab, but when they do, it can be expensive.

[meem120]

United Plan G.  Keep in mind all the supplemental plans are the same across the insurance companies.  Just you enter your zip and see what's available in your area and the cost. Costs have a wide range across states. They're not all the same. 

[LavernLuvsShoes]

Perhaps my situation is rare, but the only medical condition I have is Asthma...

I am retired, and on Medicare, and I have an AARP United Healthcare Medicare Advantage Plan.

I have NO monthly premiums, NO co-pays, and my (one) monthly prescription is only $47 (versus the $400 I paid before signing up for the UHC plan)

It includes Dental, Vision, Hearing and a $200 a year OTC drug store purchase allowance.

Everyone is different, but I consulted a UHC insurance agent, and I'm so glad I did.

[Effie54]

---

@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.