Wellness

[Mom2Dogs]

On 4/9/2015 terrier3 said:

On 4/9/2015 Gooday said:

I want to ask a serious question to those who are Medicare eligible: other than cost, why would you pick an Advantage plan over Medicare with a supplemental? Aren't you limited as to where you have to be seen? Can you go to ANY doctor at ANY facility? Are they all HMO's?

I am nearly 62 and have Blue Cross/Blue Shield PPO through my retired husband's job. However, the premiums are astronomical. He is Medicare with the PPO supplemental. It's my premium that is ridiculous. However, I have no plans on changing until I hit Medicare age. Then, we'll see what the situation is at that time.

Would someone answer/explain the above question? My husband is covered thru OPERS (he was a state employee at one time in OHIO) and his coverage is thru Humana along with Medicare A and B. When we had a claim it was explained to me that he does not have a supplement and does not need one with the Humana plan he is on. By the end of this year OPERS is no longer handling the insurance and we will have to pick a new plan....what is the benefit of the plan he is on now vs Medicare along with a purchased supplement.

We will have telephone meetings soon with a 'connector' to help us pick a plan but I would like a bit more information about what to do before we have our phone interview. Thanks

[scotnovel]

On 4/7/2015 terrier3 said:

I sell health insurance.

There are many independent places you can go to compare plans - your local senior services department, an independent insurance broker, seminars and health fairs...the booklet you get every year from the feds before open enrollment in the Fall, etc.

Seniors are lucky in this regard - MANY groups are out there to help.

This is a good time to start comparing since you can't switch until October. The insurance companies always keep the best and most experienced benefit consultants on year-round - and they have plenty of time to talk to you now.

You have to SEEK OUT assistance - there are strict laws re: soliciting for Medicare clients.

Good luck!

You do not have to "SEEK OUT" assistance. I will be 65 in May and I have gotten a number of solicitations from several different insurance companies and private insurance agencies that work only with seniors. Earlier this week I purchased my supplemental policy and drug plan through an insurance agency that sent me a letter addressed to "Dear Prospective Customer". I researched the agency and the agent with the state insurance board before I contacted them for advice. I also did my own online research on the different plans available to me and could have signed up without the agent but he did a great job of clarifying the options and explaining about the various companies, their history of price increases etc. It was well worth taking to an expert.

[terrier3]

On 4/9/2015 Scotnovel said:

On 4/7/2015 terrier3 said:

I sell health insurance.

There are many independent places you can go to compare plans - your local senior services department, an independent insurance broker, seminars and health fairs...the booklet you get every year from the feds before open enrollment in the Fall, etc.

Seniors are lucky in this regard - MANY groups are out there to help.

This is a good time to start comparing since you can't switch until October. The insurance companies always keep the best and most experienced benefit consultants on year-round - and they have plenty of time to talk to you now.

You have to SEEK OUT assistance - there are strict laws re: soliciting for Medicare clients.

Good luck!

You do not have to "SEEK OUT" assistance. I will be 65 in May and I have gotten a number of solicitations from several different insurance companies and private insurance agencies that work only with seniors. Earlier this week I purchased my supplemental policy and drug plan through an insurance agency that sent me a letter addressed to "Dear Prospective Customer". I researched the agency and the agent with the state insurance board before I contacted them for advice. I also did my own online research on the different plans available to me and could have signed up without the agent but he did a great job of clarifying the options and explaining about the various companies, their history of price increases etc. It was well worth taking to an expert.

FYI - It is illegal for plans to call you to solicit your business (unless you are already a customer). I stand by what I stated - there are VERY strict rules re: solicitation for Medicare enrollees.

There IS a lot of help out there though...but you have to call them, they cannot call you.

http://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/health-plans-rules/health-pl...

[GrailSeeker]

On 4/9/2015 momtodogs said:

On 4/9/2015 terrier3 said:

On 4/9/2015 Gooday said:

I want to ask a serious question to those who are Medicare eligible: other than cost, why would you pick an Advantage plan over Medicare with a supplemental? Aren't you limited as to where you have to be seen? Can you go to ANY doctor at ANY facility? Are they all HMO's?

I am nearly 62 and have Blue Cross/Blue Shield PPO through my retired husband's job. However, the premiums are astronomical. He is Medicare with the PPO supplemental. It's my premium that is ridiculous. However, I have no plans on changing until I hit Medicare age. Then, we'll see what the situation is at that time.

Would someone answer/explain the above question? My husband is covered thru OPERS (he was a state employee at one time in OHIO) and his coverage is thru Humana along with Medicare A and B. When we had a claim it was explained to me that he does not have a supplement and does not need one with the Humana plan he is on. By the end of this year OPERS is no longer handling the insurance and we will have to pick a new plan....what is the benefit of the plan he is on now vs Medicare along with a purchased supplement.

We will have telephone meetings soon with a 'connector' to help us pick a plan but I would like a bit more information about what to do before we have our phone interview. Thanks

I bill Medicare at my job. A Medicare Advantage Plan is the only way to get prescription coverage. Original Medicare does not cover prescriptions. Many times, a Medicare Advantage Plan is less expensive than original Medicare and a supplement. Just be aware that you are responsible for co-pays and deductibles. However, you will pay as you go, instead of a monthly premium to pay for a supplement.

[Mom2Dogs]

Grailseeker...thank you, now I understand a little better...I used to understand our insurance so much better, now, I seem to have lost my touch. I am making a list of questions to ask the 'connector' that OPERS is making available to us. Again, thanks.

[goodstuff]

On 4/9/2015 Gooday said:

I want to ask a serious question to those who are Medicare eligible: other than cost, why would you pick an Advantage plan over Medicare with a supplemental? Aren't you limited as to where you have to be seen? Can you go to ANY doctor at ANY facility? Are they all HMO's?

I am nearly 62 and have Blue Cross/Blue Shield PPO through my retired husband's job. However, the premiums are astronomical. He is Medicare with the PPO supplemental. It's my premium that is ridiculous. However, I have no plans on changing until I hit Medicare age. Then, we'll see what the situation is at that time.

Because Medicare Advantage plans are simple, all-in-one plans, and the premiums are generally lower per month than paying Medicare Part B plus the higher monthly premium for a Medicare supplement. Advantage plans usually run like HMO's and have limited networks of providers and facilities -- but if you're on a very tight budget or don't feel competent to shop for providers and services, some may consider an Advantage plan a good thing. Personally, I prefer Medicare plus a supplemental plan.

[goodstuff]

On 4/9/2015 GrailSeeker said:

On 4/9/2015 momtodogs said:

On 4/9/2015 terrier3 said:

On 4/9/2015 Gooday said:

I want to ask a serious question to those who are Medicare eligible: other than cost, why would you pick an Advantage plan over Medicare with a supplemental? Aren't you limited as to where you have to be seen? Can you go to ANY doctor at ANY facility? Are they all HMO's?

I am nearly 62 and have Blue Cross/Blue Shield PPO through my retired husband's job. However, the premiums are astronomical. He is Medicare with the PPO supplemental. It's my premium that is ridiculous. However, I have no plans on changing until I hit Medicare age. Then, we'll see what the situation is at that time.

Would someone answer/explain the above question? My husband is covered thru OPERS (he was a state employee at one time in OHIO) and his coverage is thru Humana along with Medicare A and B. When we had a claim it was explained to me that he does not have a supplement and does not need one with the Humana plan he is on. By the end of this year OPERS is no longer handling the insurance and we will have to pick a new plan....what is the benefit of the plan he is on now vs Medicare along with a purchased supplement.

We will have telephone meetings soon with a 'connector' to help us pick a plan but I would like a bit more information about what to do before we have our phone interview. Thanks

I bill Medicare at my job. A Medicare Advantage Plan is the only way to get prescription coverage. Original Medicare does not cover prescriptions. Many times, a Medicare Advantage Plan is less expensive than original Medicare and a supplement. Just be aware that you are responsible for co-pays and deductibles. However, you will pay as you go, instead of a monthly premium to pay for a supplement.

If you have Medicare plus a supplement, you'll need to sign up for a separate Part D drug plan to cover prescriptions. There are dozens on the market. DH has a very reasonable one through Humana; I have one through Silverscripts. Prescriptions aren't covered under your Medicare or supplement plan, but you can certainly buy a Medicare prescription plan, some of them quite reasonable. Medicare Advantage plans are all-in-one and include drug coverage.

I suggest again that people facing choices about Medicare plans find a good insurance agency who can help you navigate the sea of costs, coverages, and options.

[KailaS]

I cannot answer your question, but I must comment. I am a cancer patient and was seriously ill before I retired. I have traditional Medicare, a Plan F supplemental plan ( If you do not know: supplemental plans cover different costs that are not covered under traditional Medicare. Plan F is the top plan right now.), and a Script Plan. Because of all of the Tier five drugs I take, I pay pretty much out of pocket for Scripts. A Medicare Advantage plan would limit my choice of doctors and would end up costing me a great deal more than the plans I have set up. Those plans cost me more for premiums, but they save me so much in out of pocket expenses for care throughout each year.

[Mmsfoxxie]

This so confusing. I will retire in June so I'm getting ready to talk to an insurance navigator. It sounds like most of you are saying that if your health is pretty good and you don't have a lot of prescriptions then Medicare with a supplement for drugs is fine. Or Medicare advantage which would cover everything. Hmo is fine with me because that's what I've always had.

[gidgetgh]

I'm veering off topic by just a little, but my husband has Medicare, a Plan F supplement with Blue Cross and Express Scripts for prescription coverage.

He was hospitalized in late January and between the hospital and a rehab center, he was away from home for 26 days. 12 days in the hospital, countless tests, colon surgery, then 14 days in the rehab center. $169K hospital bill, @$12K rehab bill, 2 ambulance transports and various pathologists and radiologists, labs, pharmacy costs inpatient, etc. We paid $0. Everything was paid by Medicare and Blue Cross. We didn't even have hospital "per day" co-pays.

The premium might be more, but if you need it, it's worth every cent. At least to us.