I Finally Changed My Medicare Coverage To A PPO

[OneEyedDiva]

I didn't have to wait until next until the next Medicare enrollment period to change from Aetna Open Access Medicare to Aetna Medicare Advantage PPO through the State Health Benefits retiree plan (NJSHB). I've been meaning to do it since it was first offered a couple of years ago. It seemed like a better plan. The two reps I spoke with at the NJSHB office (on separate calls) said it is a better plan. The first year it was offered, there was a grid showing the different co-pays and benefits but since the PPO was a new offering, nobody seemed to know how it would affect prescription costs.

Last year I saw a grid which led me to believe the meds might cost a quite a bit more. This year I couldn't find a similar grid so I had the young lady send it to me. I realized the differences in costs are minute and using the mail in pharmacy (which I mostly use) the generics are the same. The office co-pay for the PPO will be the same for in network and out of network doctors and specialists, $10 per visit, which is what I'm currently paying. From the comparisons on the grid, it seems all other benefits, including free lab testing and imaging as well as free in home nursing care for up to 35 hours a week are the same. My new coverage will begin on 5/1/22. Although it sounds like a very good plan, I was still a little apprehensive about making the change.

 

[Pepper]

I can't have an insurance co. telling me which doctors or hospitals I can't go to. I'm too nervous for that.

 

[OneEyedDiva]

I can't have an insurance co. telling me which doctors or hospitals I can't go to. I'm too nervous for that.

I've never had a problem finding good doctors within my network, even decades ago when my insurer was Healthways. Over time I wound up with Aetna coverage. I'm glad I didn't choose Blue Cross and Blue Shield..their coverage is sucky. I never had to pay for health insurance (as part of my employee/retiree benefits) until I got Medicare coverage. Several years ago, I thought I'd need to have a cyst removed. I had evaluations by a doctor who was affiliated with our local hospital and she recommended me to another doctor a few towns away who was affiliated with the hospital closer to her office. I really liked new doctor a lot, felt very comfortable with her. All involved took my insurance which was regular Aetna at the time. Turns out the cyst burst on it's own so I didn't need surgery.

I have been blessed to find wonderful doctors and specialists who take Aetna. I even found a great foot doctor. My gastroenterologist just retired this month and I've never seen his partner so I hope I like him as much as I liked Dr. K., who took care of my mother and me for decades. I'm glad I had my colonoscopy last year. Next month when the PPO coverage starts, whatever doctor I choose will be covered.

 

[Don M.]

We've had a Humana Medicare Advantage PPO plan, for years, with the premiums paid for by my previous employer. It has worked well, with plenty of services in their "network". The co-pays, etc., have been quite reasonable.

 

[Butterfly]

I've had an Advantage plan since I first had Medicare, and have been quite happy with it. It has a huge network of physicians.

 

[Remy]

I'm not ready for Medicare yet but I never realized it could be so complicated until I was on this forum. Not looking forward to the sign up process.

 

[OneEyedDiva]

I'm not ready for Medicare yet but I never realized it could be so complicated until I was on this forum. Not looking forward to the sign up process.

It can get complicated. Now there are Medicare advantage parts that I don't even know what they are! I'm so glad that when it was time for me to get on Medicare, it was handled seamlessly for me by the State of N.J. Pensions and Benefits department. After proof that I'd received the government issued Medicare card, they transferred me from my regular Aetna HMO to Aetna Medicare HMO.

 

[Remy]

@OneEyedDiva I'm over 3 years out but it's never too early to start researching. I'll probably really look at threads here and Google search when I'm about a year away. Right now have Covered California and they have been decent with the cataract and carpal tunnel surgery.