Wellness

[Mom2Dogs]

I am going to print this thread, it is very helpful information....there is so much to know and when it comes my time I want to make an informed decision and we may revisit my DH policy.

again thank you.

[Carmie]

@geezerette  You made some wise well thought out decisions.  In my area, Plan G is more expensive than Plan C.  It varies.

Also, downgrading to a lesser plan in the future might not save you money for the premiums.  Insurance companies always charge more if you are out of your 6 mo personal open enrollment. So in essence, it might not be prudent to downgrade when the monthly premiums might be higher if you do.  

[geezerette]

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@Carmie wrote:

@geezerette  You made some wise well thought out decisions.  In my area, Plan G is more expensive than Plan C.  It varies.

Also, downgrading to a lesser plan in the future might not save you money for the premiums.  Insurance companies always charge more if you are out of your 6 mo personal open enrollment. So in essence, it might not be prudent to downgrade when the monthly premiums might be higher if you do. 

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@Carmie

Interesting that the plan premiums are reversed.  This is why it is so important to check out prices for your specific area and compare companies.

Yes, I realize what you are saying and I can't imagine switching to a lesser plan for myself.  What I was trying to point out is that during the initial enrollment period is the only time that you are guaranteed enrollment without underwriting and for the "going" premium price.  Once that initial period is over, all bets are off, so to speak.  

Also, those looking at MediGap coverage need to decide whether you want drug coverage as well.  They are separate policies.  Even though there are only two choices for those, the drug policies were actually more confusing for me than the medical policies.  Maybe because I don't take any prescription drugs, all those pricing tiers were mind-boggling.

[gidgetgh]

My husband has Plan F through Blue Cross of Georgia. 

No co-pays,  no deductible. 

My husband has Parkinson's Disease and in 2015 had colon cancer. He had surgery for that and spent two weeks in rehab after the surgery.

For all of this, we've never received one medical bill or had to pay one penny toward his medical care, except for the premiums.

Prescriptions though are another story.  

[Mom2Dogs]

@Carmie....I am reading about supplemental policies and see the term 'original' medicare....are there two different Medicare plans?

[pepes mom]

momtodogs:  There is original Medicare, in which you can just carry that or add a Medigap policy and then there's the Medicare Advantage plans.

I am on disability.  I have Medicare parts A and B and a Medigap Plan F through Mutual Of Omaha.  I was in the hospital 2 years ago for a kidney stone.  Upon CT scan, they found a HUGE blood clot in my renal vein.  I didn't receive any paperwork regarding my hospital stay.  Everything was paid for.

Due to finding that clot, I am now on Coumadin for life.  I get bloodwork every 2 weeks.  I have never received a bill for that either.

[Carmie]

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@Mom2Dogs wrote:

@Carmie....I am reading about supplemental policies and see the term 'original' medicare....are there two different Medicare plans?

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Original or a Traditional Medicare is the Medicare that has been around since 1965.  This plan was setup for people on SS, but it did not cover every medical bill at100%.  Then insurance companies started to sell insurance to cover the "gap" so that coverage could cover these out of pocket expenses called Medigap supplemental policies.

At the time, the policies were not regulated and varied greatly.

Then the Advantage Plans were offered in addition to Original Medicare around 1997.  Now people could choose between two types of Medicare... Original and Advantage.  

[geezerette]

Medicare “Advantage” is a version of Medicare that was started some time ago and it is what used to be called an “HMO”, or a managed plan. With this you still need Medicare Parts A and B from the government. But this is where the two Medicares differ. With Original you are responsible for the 20% not covered by Parts A and B.

With Advantage, an insurance company will accept from the government the money from your Parts A and B and you do not have that 20% responsibility, and typically you have less out-of-pocket expenses for co-pay and deductibles.  However, the trade-off is that also typically your options are limited for medical care. You are limited to a network of doctors/hospitals, etc. Your insurance company has more control over who you see and when, just like in any managed plan.

Many people like it because it usually is less expensive than Original Medicare. But others do not like it if they don't have the access to the type of care they want. It is something to research carefully.

[Carmie]

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@geezerette wrote:

Medicare “Advantage” is a version of Medicare that was started some time ago and it is what used to be called an “HMO”, or a managed plan. With this you still need Medicare Parts A and B from the government. But this is where the two Medicares differ. With Original you are responsible for the 20% not covered by Parts A and B.

With Advantage, an insurance company will accept from the government the money from your Parts A and B and you do not have that 20% responsibility, and typically you have less out-of-pocket expenses for co-pay and deductibles.  However, the trade-off is that also typically your options are limited for medical care. You are limited to a network of doctors/hospitals, etc. Your insurance company has more control over who you see and when, just like in any managed plan.

Many people like it because it usually is less expensive than Original Medicare. But others do not like it if they don't have the access to the type of care they want. It is something to research carefully.

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Some parts of what you wrote are true and some are not. Advantage plans are not all managed Plans.  Some are HMO and some are PPO.  PPO plans are not managed care. There are usually out of pocket expenses for services that the patient must pay for.  They cannot get a Medigap policy to pay for these fees.  You do not have Medicare Parts A and B with Advantage Plans, but you still have the Medicare B payment taken from your SS check.

Most Advantage Plans have deductibles for an inpatient hospital stay.  Some are $200 a day or more for each day up to about day seven.  So if you are in the hospital for one week, you would owe $1400.

if you had Original Medicare you would owe $1316.  Then if you went home and were readmitted  within the same benefit period, you would not have to pay the deductible again.

Most Advantage plans would charge a deductible each time you are admitted and not just once during a benefit period.

With Advantage plans you have to pay out of pocket each time to go to your doctor and if the doctor is a specialist, the out of pocket is higher then your PCP.  Some of these fees are a hefty $40 to $70 a visit.

People who really like Advantage Plans are mostly healthy people.  The plans also can include vision, RX, dental, hearing aid and gym memberships which appeal to people.  This type of coverage is less expensive to buy, but not always a good value if someone is very sick and sees many specialists or is in and out of the hospital a lot.  There are MANY copays and deductibles involved in Advantage Plans.

The problem with Advantage Plans is that you are locked into them for life if you choose them.  Yes, you can always switch back to Original Medicare, but you will not be able to get a Medigap or RX policy that is affordable.  Some companies will not even offer you a Medigap policy when you switch.

The Advantage  Plans out there are better in some states than others.  Florida sells some really great Plans, probably because they have a larger senior population. In Pennsylvania, they are awful.  

You have to be really careful and do your homework before you decide. Advantage plans are not all bad I will admit, but, they vary greatly and can be tricky.  I would never feel comfortable with an Advantage HMO Plan for myself because I travel and they are too managed and complicated.

[Mom2Dogs]

.....I am aware of Medicare and Medicare Advantage, my husband had medicare advantage at one time.... I have just never heard the term 'original' medicare that is what was confusing me...why can't they just use the words Medicare and Medicare Advantage...it would make things a bit easier to understand.