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10-23-2014 05:16 PM
They discussed United Health Care - Humana and Etna plans that are available in Florida. Nothing new really for me - they have changed how they will pay for tier 3,4 and 5 medications but we had already gotten a letter from UHC warning us about that.Our ins will now have a deductible of $200 before they pay for tier 3 & 4 and the tier 5 they pay a % and the customer pays the rest. I believe tier 5 drugs are usually chemo drugs. I had never heard of tier 5 before so this took me by surprise. Of course our plan has a yearly total in case of catastrophic illness of $6700 - so no matter what that is your yearly out of pocket total. Another thing he told us about was a month long - Jan to Feb - medicare advantage disenrollment period when you can chose to change from an advantage plan to regular medicare. Good thing to know.
So , while these changes are on my plan here in SW Fl. they usually reflect the rest of the country so if you have an advantage plan and they would affect you - I would look at my Medicare and you book or call my company's customer service dept. or my agent to check on these things. Our ins agent is who has these meetings for his customer's every year. AARP also has online town hall meetings - or they have in the past - so you could check there.
10-24-2014 12:28 PM
I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?
Doesn't make sense to me ........
10-24-2014 12:36 PM
Thanks for the info. My husband and I are not eligible yet, but close; he currently works and we have insurance through the agency he works for, but I am trying to get a handle on this whole thing before we are in it.
10-24-2014 12:44 PM
I love it when people care enough to attend town hall meetings and be more informed about the things that impact their lives. Thanks for attending and sharing what you learned.
10-24-2014 12:46 PM
On 10/24/2014 Tinkrbl44 said:I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?
Doesn't make sense to me ........
Medicare Advantage Plans (MAP) are provided by insurers to Medicare recipients who agree to use their plan doctors, hospitals and other providers exclusively. If you choose a MA PLan, Medicare then pays the plan a flat amount to provide you with all the care that Medicare would provide. This is called capitation. I don't know what the capitation amount is now. It varies by region. I know that in SoCal about 15 years ago the capitation was $940/month for Kaiser Permanente. That $940 was to cover all your health care provided by Kaiser. So, if you didn't get sick Kaiser got to keep the money. If you went to the hospital then Kaiser had to eat the cost. There are a lot of variables that go into the formula for capitation. This is just a quick and dirty explanation.
If the plan provides more than Medicare provides, e.g., a fitness program or dental, then the MAP is permitted to charge you a premium for those. Those plans that offer $0 and $0 deductible are either non-profits (such as SCAN in SoCal) or they offer just what Medicare requires them to offer.
Hope this answer helps.
10-24-2014 12:51 PM
On 10/24/2014 Tinkrbl44 said:I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?
Doesn't make sense to me ........
I have Blue Shield and they deduct your premium from your Social Security. It is $104.90 for me. So you do pay a monthly premium.
10-24-2014 01:07 PM
On 10/24/2014 ChouChou said:On 10/24/2014 Tinkrbl44 said:I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?
Doesn't make sense to me ........
Medicare Advantage Plans (MAP) are provided by insurers to Medicare recipients who agree to use their plan doctors, hospitals and other providers exclusively. If you choose a MA PLan, Medicare then pays the plan a flat amount to provide you with all the care that Medicare would provide. This is called capitation. I don't know what the capitation amount is now. It varies by region. I know that in SoCal about 15 years ago the capitation was $940/month for Kaiser Permanente. That $940 was to cover all your health care provided by Kaiser. So, if you didn't get sick Kaiser got to keep the money. If you went to the hospital then Kaiser had to eat the cost. There are a lot of variables that go into the formula for capitation. This is just a quick and dirty explanation.
If the plan provides more than Medicare provides, e.g., a fitness program or dental, then the MAP is permitted to charge you a premium for those. Those plans that offer $0 and $0 deductible are either non-profits (such as SCAN in SoCal) or they offer just what Medicare requires them to offer.
Hope this answer helps.
This is not entirely correct information. First - while most advantage plans are HMOs they also offer POS plans and PPO plans. We are in a PPO plan, because we travel and need more flexibility than an HMO offers. second - we are in a $0 premium plan but we do get extras. We get basic dental and vision and The HMO version gets silver sneakers and we have benefits such as last year I participated in a avoiding diabetes program at the YMCA they paid 100% for. Definitely not just the basics that medicare requires of them.
10-24-2014 01:09 PM
On 10/24/2014 Tinkrbl44 said:I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?
Doesn't make sense to me ........
Just to be clear, our Medicare charge is currently $104.90/mo whether you are on Social Security or not. My husband is on Medicare (he just turned 65) but has not yet applied for Social Security. We pay the $104 directly to Medicare and they pay the Advantage plan that he has selected. So while the Advantage plan advertises no additional premium, we all pay the basic medicare fee. If you are on Social Security, they usually deduct the Medicare fee from that. Most Advantage plans offer more than you would get with basic Medicare, which is why people sign up for them.
10-24-2014 01:09 PM
On 10/24/2014 elated said:On 10/24/2014 Tinkrbl44 said:I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?
Doesn't make sense to me ........
I have Blue Shield and they deduct your premium from your Social Security. It is $104.90 for me. So you do pay a monthly premium.
True and that is paid to the ins co by medicare. That amount deducted from your SS check is called your part B payment.You would have to pay that no matter if you had a supplement or an advantage plan or neither.
Also discussed at the town hall meeting yesterday was the part D - Rx plan. If a person does not buy a Rx plan they are assessed a fine that can be very steep and is deducted from SS check. You are required to have it. Medicare advantage plans generally include the Rx plan - but supplements rarely do and so you have to buy them in addition to your supplement. (just to be perfectly clear before some uninformed person blames this on the ACA - it is part of the law passed during the B*sh administration that enacted the part D Rx coverage)
10-24-2014 04:26 PM
My DH will go on Medicare Jan. 1st. He is not yet 65 (will be in July), but he has Alzheimers and is on ss disability. I have an appointment with a gal who will help me wade through all the information of what plan to get. I dread it. It seems so darned complicated, plus I have to decide if I want to keep my own plan with CA Affordable Care. I hope I make the right choices!
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