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Esteemed Contributor
Posts: 5,419
Registered: ‎03-09-2010

Re: Looking for a Medicare PPO Supplemental

Here is info about selecting PPO plans by state from Consumer Reports. A drop down menu. The info about Medicare is free. http://www.consumerreports.org/health/insurance/health-insurance-plans.htm

The front page http://www.consumerreports.org/cro/2012/09/managing-medicare/index.htm

Most of this info is from 2014.

Honored Contributor
Posts: 39,574
Registered: ‎08-23-2010

Re: Looking for a Medicare PPO Supplemental

You don't mention what state you're in, so there could be variables from what other information you receive on here.

Basically, a Medicare Advantage plan is the "HMO version" with referrals to their doctors.

Sound like what you want is traditional Medicare with a Medicare supplement AND a Prescription plan ..... then you can go to any MD that accepts Medicare. Take a look at Plan N in the supplement plans.

Also, if you have a Walmart near you that fills prescriptions, look at the Humana-Walmart Rx Drug policy .... (they partnered together) ..... it's very inexpensive, and covers a LOT. {#emotions_dlg.thumbup1}

Hope this helps.

Tink

Honored Contributor
Posts: 13,954
Registered: ‎03-10-2010

Re: Looking for a Medicare PPO Supplemental

If you like your doctors and like the current company, why not call your BCBS provider?

It's "slow season" and they will be able to give you plenty of time to discuss options with you.

Then you will have a basis to compare with other companies and plans.

Respected Contributor
Posts: 4,627
Registered: ‎03-10-2010

Re: Looking for a Medicare PPO Supplemental

Find an independent agent who can help you understand the different medigap supplement plans.... what they cover and the price points. There are so many options, an independent agent is very helpful.

Trusted Contributor
Posts: 1,973
Registered: ‎03-09-2010

Re: Looking for a Medicare PPO Supplemental

When I had to choose a plan-it was very confusing! I live in PA, and we are having a big battle between Highmark and UPMC. I have doctors within both plans, so I had to choose a plan that they would both accept. I also have a chronic, expensive health problem. Be sure to look at per visit deductibles and the maximum out of pocket deductible.

That was important to me since I see several specialists and get an expensive cancer medication every 3 weeks. This year the rates went up, (of course). I pay $115 premium per month, $0 for PCP, $30 for specialist visits and my out of pocket is $6700/year. My plan goes from Jan 1st to Dec,31st. Some plans start counting when you contract with them. Prescriptions are thru Express Scripts, (mail order) or Rite-Aide, and seem competitively priced.

I have a Coventry Advantra PPO. It was recommended by my oncologists office.

Honored Contributor
Posts: 13,954
Registered: ‎03-10-2010

Re: Looking for a Medicare PPO Supplemental

On 1/29/2015 lacey1 said:

When I had to choose a plan-it was very confusing! I live in PA, and we are having a big battle between Highmark and UPMC. I have doctors within both plans, so I had to choose a plan that they would both accept. I also have a chronic, expensive health problem. Be sure to look at per visit deductibles and the maximum out of pocket deductible.

That was important to me since I see several specialists and get an expensive cancer medication every 3 weeks. This year the rates went up, (of course). I pay $115 premium per month, $0 for PCP, $30 for specialist visits and my out of pocket is $6700/year. My plan goes from Jan 1st to Dec,31st. Some plans start counting when you contract with them. Prescriptions are thru Express Scripts, (mail order) or Rite-Aide, and seem competitively priced.

I have a Coventry Advantra PPO. It was recommended by my oncologists office.

I like your advice.

I think it's better to check with your medical providers rather than an insurance agent.

Your providers will be able to help you determine what plans are best for you (and them!).

Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: Looking for a Medicare PPO Supplemental

On 1/28/2015 Frannie said:

Not all HMOs require a referral to a specialist. In fact with our insurance it's the opposite - PPO requires a referral - HMO does not. Also with our PPO (Aetna) hubby would have had to pay the Medicare deductible - with UPMC HMO he did not.

A PPO stands for Preferred provider organization. That means you can use ANY doctor but it is less expensive to use the ones IN NETWORK. Thus - to state that a PPO requires a referral would be exactly opposite of the reason people buy a PPO - to have the freedom to go to any doctor.

I have never heard of an HMO that did not require a referral as staying within the network is a requirement of all HMO organizations.HMO's do not pay if you go outside their network.

Please be certain you have your information correctly as a mistake can cost you dearly.

When we were in Zelienople 2 years ago both DH and I had the flu so we went to a urgent care place owned by UPMC - they would not take our United Health Care plan and we had to pay cash - so we called UHC and they reimbursed us. IMO - any thing UPMC stinks - and I worked for them for 10 years before I retired. However, if I still lived in the Pittsburgh area - because they control such a huge portion of the healthcare available there - I would have a UPMC plan.

Regular Contributor
Posts: 177
Registered: ‎03-10-2010

Re: Looking for a Medicare PPO Supplemental

Please take the time to do the appropriate research before making such a crucial set of decisions. The best place to start is by getting a copy of "Medicare and You" from your local Social Security Administration office. It's a lengthy paper book filled with information and explanations. (I believe it is also available online.) You should visit the www.medicare.gov website for lots of additional information.

You can also contact your state Insurance Administration or Insurance Department. Just about every state has a "SHIP" program-- Senior Health Information Program-- that can give you information about health plans operating in your state.

You must base your choices on the plans that are operating in your state or local area. So if someone on this forum says "I love Plan zzzzzz" it is irrelevant unless such a plan is available in your local area.

For prescription drug coverage (Medicare Part D) you can go on the medicare website and enter the exact medications you take, including the dosage, and the online calculator will compare Part D drug plans in your area and show you exactly how much you would have to pay in both premiums and out of pocket expenses for your exact medications.

If you have access to health insurance from an employer, you can keep it and your costs will likely go down because basic Part A Medicare is free and acts as a secondary insurer after your employer plan pays. But because Medicare is sharing some of the expenses, your employer plan premium for you would likely be lower.

One factor to consider: AARP/United Healthcare Supplemental (Medigap) is one of the few plans that is "community rated" instead of "age at issue." That means that premiums only go up based upon the total group, not your personal age. But many other plans that look cheap when you first go into them escalate in premiums exponentially as you get older.

This can be important if you have pre-existing conditions. When you first go on Medicare, the supplemental plans have to take you with no questions asked about your medical history. But if you switch plans later, the plans can and do ask questions and might deny coverage down the road.

Regular Contributor
Posts: 177
Registered: ‎03-10-2010

Re: Looking for a Medicare PPO Supplemental

I should add that you definitely should sign up for Medicare as soon as you turn 65. There's no advantage in delaying and in some cases there are penalties for late enrollment. And in particular, keep whatever drug coverage you now have until you pick a Part D drug plan-- there are penalties and possibility of being denied coverage by a private drug plan if you go without coverage for too long (I think it is 63 days) before signing up for the new Part D plan.

Trusted Contributor
Posts: 1,973
Registered: ‎03-09-2010

Re: Looking for a Medicare PPO Supplemental

PS: I vote for quality, free healthcare for the whole country, (if anyone's listening). Maybe they could raise the money by taxing cigarettes and liquor, heavy penalties for DUI, legalizing gambling and marijuana, wait a minute. They already did that.