Wellness

[151949]

@pdlinda This is what we have - we are going for the PPO this year. A couple years ago I had knee surgery and the lady who took my insurance info at the hospital told me that about 3/4 of all the people she sees have the same insurance we have. That was reassuring.

[Winkk]

Unless something drastic changes to my Keystone 65 (an advantage plan)  I'm staying with them.  I live in the Philly suburbs and Keystone 65 is run by Blue Cross.  It is an HMO but I have no problems getting referrals to specialists.  So far, every doctor I wanted to see has been covered.

I hope everything stays about the same as this year.

[151949]

It appears that people who have supplements tend to put down advantage plans but those who have advantage plans are very satisfied with them. Can't beat the low cost - we find that , in general, our yearly out of pocket is much lower than the premiums would be on a supplement & Rx plan. Of course there is a little bit more to deal with but we are used to that as we had HMO insurance for years before we retired.

[Tinkrbl44]

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@151949 wrote:

It appears that people who have supplements tend to put down advantage plans but those who have advantage plans are very satisfied with them. Can't beat the low cost - we find that , in general, our yearly out of pocket is much lower than the premiums would be on a supplement & Rx plan. Of course there is a little bit more to deal with but we are used to that as we had HMO insurance for years before we retired.

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@151949

I had to click on your thread because I thought you were talking about vitamin supplements!   LOL  I didn't realize you were referring to open enrollment.

It's a tricky process, but if you don't mind the HMO gate keeper thing, it can work well for you.  For those who've never had an HMO, it can be much too restrictive because usually they can't continue to see doctors they've had for a long time.  Depends on how flexible you're willing to be.

[151949]

@Tinkrbl44  You can get a advantage plan that is a PPO as well as an HMO and there is no "gatekeeper" thing to deal with.You can see any doctor you wish - although iot may be a higher co pay. For instance when we had our PPO our out of network copay was $20 more for an office visit.

[proudlyfromNJ]

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@Tinkrbl44 wrote:

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@151949 wrote:

It appears that people who have supplements tend to put down advantage plans but those who have advantage plans are very satisfied with them. Can't beat the low cost - we find that , in general, our yearly out of pocket is much lower than the premiums would be on a supplement & Rx plan. Of course there is a little bit more to deal with but we are used to that as we had HMO insurance for years before we retired.

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@151949

I had to click on your thread because I thought you were talking about vitamin supplements!   LOL  I didn't realize you were referring to open enrollment.

It's a tricky process, but if you don't mind the HMO gate keeper thing, it can work well for you.  For those who've never had an HMO, it can be much too restrictive because usually they can't continue to see doctors they've had for a long time.  Depends on how flexible you're willing to be.

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My Advantage plan is a PPO, not an HMO.

[Moonchilde]

Those who live in large or fairly large urban areas have every choice when it comes to MA plans - several different companies and different plans within.

Those who live in more sparsely populated areas of less density just do not have those options, due to the way Medicare "decides" for you where you need to be going to the doctor. I could drive 10-15 miles and be eligible for a MA plan, which I would be more than willing to do, but Medicare says no. I could drive an hour and have my pick of MA plans - again no. Medicare decides what you can and can't have access to by zip code apparently.

There is no "true" MA plan available to me whatsoever except a local doctor-run plan whose fees are *nothing* like actual MA plans. It's that or a supplement. I chose the supplement because the supposed MA plan would have cost me bigtime in co-pays that most real MA plans don't have.

I was in an HMO for at least 15 years while working. I hated it, but could not afford the PPO cost. So, I'm very familiar with how HMOs work. To me, the small amount more that I pay for a supplement and Part D vs what I might pay for a MA plan is doable. I'm content so far to go to the referrals my doctor gives me, because I don't know the area. But if I was referred to a doctor I really didn't like it's great to know I could switch if I wanted to.

[151949]

Actually, I live in a very small town but I have the choice of many medicare advantage plans.Etna, humana, Optima, United Healthcare, BC/BS and others. Unfortunately in our area there are two large medical practice groups and they totally dominate - almost impossible to find doctors who aren't in one or the other. IMO - these large groups are terrible for the consumer - esp. when ins. gets involved.