I Thought I Would Keep My Medicare Plan But....

OneEyedDiva

OneEyedDiva

SF VIP
Location
New Jersey
The State of N.J. threw me a curve ball. I have Aetna Open Access Medicare, which I love, but now the state retiree health benefits program is offering an Aetna Medicare PPO which is supposed to be better. One main difference is that I can visit out of network doctors as long as they take Medicare and I'd pay the same co-pay as in network doctors ($10). Another is that should I need a chiropractor and/or acupuncture, those are covered It touts lower premiums but I don't think that applies to us who have the basic premium taken out of our social security.

I got some questions answered during a conference call regarding the new plan about a month ago but will call and speak one on one with a state representative to clarify some things. One caveat may turn out to be the difference in what I'd pay for prescription drugs, as stated in the booklet explaining RX prices may be affected by a difference in plans. Thing is the RX company can't tell the difference costs until January 2020. The good thing is I can switch anytime (even after Medicare's deadline) but I'd have to keep the new plan for 12 months, satisfied or not.
 

Generally, a PPO will give you much greater access to physcians than an HMO, even one of the "open access" variety. I don't believe you can count on out of network seeing you for a $10 copay however out of area doctors that are part of the nationwide Aetna network are available to you. It's one of the selling points to their PPO.

Rick
 
GreenSky said:
Generally, a PPO will give you much greater access to physcians than an HMO, even one of the "open access" variety. I don't believe you can count on out of network seeing you for a $10 copay however out of area doctors that are part of the nationwide Aetna network are available to you. It's one of the selling points to their PPO.

Rick
Click to expand...
Thank you for your feedback Rick. According to the comparison chart of both plans that Aetna sent it states: "See any provider who is eligible to accept Medicare payment and accepts (Medicare) and pay the same co-pay (as listed on your plan benefits summary) as if the provider was in network". The co-pay for both the HMO and PPO is $10 for 2020. Now whether they will reimburse us any additional amount charged above the set co-pay or how it would work, I don't know....but that's a good question to ask.
 


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