Wellness

[Cakers3]

@Moonchilde  There is one downside to an Advantage plan in that they do not always pick up the slack that Medicare leaves for certain test/ procedures.  The Medicare book advises about this.  They have the option to pick up part or all of what Medicare doesn't.

My understanding, too, is that the Supplemental F and G plans are the best.

We are content right now with our Advantage plan but will still shop around when the open enrollments start up again.

The deductibles/out of pocket are very high, too, with some plans vs. Medicare.

It's a lot of material to cover depending upon one's finances, health needs, etc.

@goldensrbest

[Moonchilde]

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@Caligurll wrote:

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@goldensrbest wrote:

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@Caligurll wrote:

I have an advantage plan, and my eye exam is $15 co-pay and then $150 credit towards a pair of glasses, every two years.

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Would you mind telling me what you have,and monthy what is the cost?

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@goldensrbestI have Kaiser and it is about $200 a month (the northern California rate, for retirees from the Federal government), in addition to my Medicare (right now $405 every three months).  

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And just as a comparison - my supplement premium is about $130/mo. I pay about $35/mo for vision insurance on my own. All but $100 of my $850 eyeglasses are covered and my exam also has a small co-pay. I pay about $28/mo For Part D. The Medicare Advantage Plan may also cover basic dental, which again, I pay for - $135/yr or $11 and change per month. Adding up all my costs, they are close to the same as Caligurl's cost. 

One is simpler and more convenient (if that's important to you), but the other is more restrictive in some ways and more generous in others - but they cost pretty close to the same.

[Caligurll]

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@Moonchilde wrote:

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@Caligurll wrote:

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@goldensrbest wrote:

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@Caligurll wrote:

I have an advantage plan, and my eye exam is $15 co-pay and then $150 credit towards a pair of glasses, every two years.

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Would you mind telling me what you have,and monthy what is the cost?

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@goldensrbestI have Kaiser and it is about $200 a month (the northern California rate, for retirees from the Federal government), in addition to my Medicare (right now $405 every three months).  

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And just as a comparison - my supplement premium is about $130/mo. I pay about $35/mo for vision insurance on my own. All but $100 of my $850 eyeglasses are covered and my exam also has a small co-pay. I pay about $28/mo For Part D. The Medicare Advantage Plan may also cover basic dental, which again, I pay for - $135/yr or $11 and change per month. Adding up all my costs, they are close to the same as Caligurl's cost. 

One is simpler and more convenient (if that's important to you), but the other is more restrictive in some ways and more generous in others - but they cost pretty close to the same.

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One more piece to my coverage.  My advantage plan comes with dental, but I still have mine through GEHA, because it pays 50-80%, depending on the service, and two cleanings per year.  Th one that comes with the advantage plan isn't nearly as good. That adds another $50 to my monthly health care, but I have more than gotten my money's worth from it.  Now if only the COLAs would keep up with the increases in Medicare and the advantage plan!

[Moonchilde]

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@Cakers3 wrote:

@Moonchilde  There is one downside to an Advantage plan in that they do not always pick up the slack that Medicare leaves for certain test/ procedures.  The Medicare book advises about this.  They have the option to pick up part or all of what Medicare doesn't.

My understanding, too, is that the Supplemental F and G plans are the best.

We are content right now with our Advantage plan but will still shop around when the open enrollments start up again.

The deductibles/out of pocket are very high, too, with some plans vs. Medicare.

It's a lot of material to cover depending upon one's finances, health needs, etc.

@goldensrbest

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@Cakers3, my insurance broker (done online and on the phone as they are in Texas - specializing in nothing but Medicare) advised me to go with G, as it offers everything that F does except that I have to pay my own Part B deductible every year, that's the only difference - and there's a hefty premium difference (to me anyway) between F and G. I wanted that '15% over and above' coverage. Who knows - maybe in 10 years more and more doctors will do that little trick :-(

I have read that for those with MA plans, it really pays to investigate what one offers and costs, exclusions, extras, etc - vs another one. Sometimes there are nasty surprises, and restrictions that are odd...and annoying and costly.

[Cakers3]

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@Moonchilde wrote:

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@Cakers3 wrote:

@Moonchilde  There is one downside to an Advantage plan in that they do not always pick up the slack that Medicare leaves for certain test/ procedures.  The Medicare book advises about this.  They have the option to pick up part or all of what Medicare doesn't.

My understanding, too, is that the Supplemental F and G plans are the best.

We are content right now with our Advantage plan but will still shop around when the open enrollments start up again.

The deductibles/out of pocket are very high, too, with some plans vs. Medicare.

It's a lot of material to cover depending upon one's finances, health needs, etc.

@goldensrbest

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@Cakers3, my insurance broker (done online and on the phone as they are in Texas - specializing in nothing but Medicare) advised me to go with G, as it offers everything that F does except that I have to pay my own Part B deductible every year, that's the only difference - and there's a hefty premium difference (to me anyway) between F and G. I wanted that '15% over and above' coverage. Who knows - maybe in 10 years more and more doctors will do that little trick :-(

I have read that for those with MA plans, it really pays to investigate what one offers and costs, exclusions, extras, etc - vs another one. Sometimes there are nasty surprises, and restrictions that are odd...and annoying and costly.

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@Moonchilde  We met our broker at the seminar I mentioned above and we all had the option to leave our names with a form indicating what we were looking for.

Then he emailed us with a date and time for a phone conference.  He was very good and I actually felt a tad guilty we didn't purchase through him but he still gets paid so I didn't lose any sleep.  LOL

The Part B deductible that Medicare charges, correct?  That is so much lower than the deductibles in the insurance plans.  Isn't it around $160??

Yes, there is more homework with a MA plan that is why I always communicate in writing with them before any test/procedure.  Back-up  the computer and also print out.  We leave no room for even $1 charge over what we expected to pay.

And yes, the G plan is supposed to be better than F but holy cannoli they are expensive; add in the Part B and Part D premiums to it and it's a hefty chunck. of $$.

We will still shop around; health wise we are ok and so far nothing has cost us a dime over except our $5 co-pay with our PCP.  Even my eye doctor exam is covered completely every year.   

Plus Silver Sneakers.   LOL  

[Moonchilde]

@Cakers3 Yes, the Part B deductible was $166/yr last year, a few dollars more this year. Part B deductibles, Part D premiums and supplement premium will go up every year like clockwork. The trick is to find a company that dings you the least of what they're all going to ding you.

When my PCP writes the referral, my eye health exam is covered by Medicare because I have diabetes. But my exams for glasses, and my eyeglasses, are always going to cost me a fortune, so it's worth it to me to have vision insurance I pay for. The premium might seem high, but it's still a few hundred cheaper than paying for it all out of pocket.

I wouldn't mind the Silver Sneakers if I could be sure it applied to somewhere I want to go, not just one place or nothing. I have so many fewer options in the country than the city. I investigated once what membership at the Y would cost. Yikes!

[CelticCrafter]

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@SilleeMee wrote:

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@SeaMaiden wrote:

What good is a ONETIME wellness checkup????  So you are healthy that one time and stay healthy year after year?? I do not get it?

 I do not know of an insurance plan that does not cover YEARLY  wellness checkups.  Please explain  how medicare charges you for coverage but does not cover a yearly exam? 

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When you sign up for Medicare then your first and only one-time "Welcome" wellness visit is covered and then after the first year you get one regular wellness visit per year covered by Medicare. The difference between these two is that the "Welcome" one basically involves getting your history down on the records so that your next year's visit can follow through, hopefully, to prevent anything unhealthy from happening or from getting worse...preventive is the key word here.

Wellness visits/exams are not the same as physical/annual checkups. 

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Personally,  I think it's plain stupid.  Unless it's a brand new doctor, shouldn't they have all that history already recorded.

[ccassaday]

First find a insurance agent that can walk you through the plans. They won't charge you anything.  My advantage plan is $35 a month. All advantage plans are different depending on your state. I have a advantage plan because in Indiana you can't get a supplemental until 65. I am on SSDI and disabled. I have been very happy with my plan. I had a very expensive jaw surgery and so far have only paid 3.45. The oral surgeon takes medicare assignment so I haven't paid anything.

[Katcat1]

@goldensrbest,  If you have Medicare don't you also have a supplemental plan with an insurance co.?  I never deal with Medicare only my supplemental insurance co. which handles everything for Medicare and I can call them any time with questions regarding coverage.

[Cakers3]

@Moonchilde  I'm not sure if one can purchase Silver Sneakers on their own but if your plan offers it, there is no cost to you.

In fact, Silver Sneakers already had us in their system; all we had to do is set up our login and the list came up with all available locations.

The one good thing is that you can go to various locations but: they may not offer all the same programs.

Some only offer the weight machines; others, like ours, offer free weights, machines, and specialty classes just for Silver Sneakers, like SS yoga, zumba, etc.  The pool is availabe to everyone.  There are other specialty short term classes that would have you paying a small fee to join.

Also you can go to a different gym if in the program; you can try out the Y or LA Fitness e.g.

I hear you about the cost of memberships, though.  We backed out of joining the Y last year because of the cost.  Now it's free for us.

Sorry you are not so close to your Y.