Medicare Part C

I would never give up my Medicare for an Advantage plan.. Call it Medicare part C if you like... BUT it is NOT Medicare.. It's an HMO operated by a private insurance company. Sounds good with all the bells and whistles it offers... UNTIL you have a major illness.. You are restricted to certain doctors and hospitals... with the insurance company calling the shots about treatment. You could be subject to horrendous co-pays particularly for outpatient services and treatments. Now I know some people are perfectly happy with their HMO... but for me.. the cost savings and extra perks (silver sneakers) is not worth giving up Medicare and the freedom Medicare provides.
 

QuickSilver said:
I would never give up my Medicare for an Advantage plan.. Call it Medicare part C if you like... BUT it is NOT Medicare.. It's an HMO operated by a private insurance company. Sounds good with all the bells and whistles it offers... UNTIL you have a major illness.. You are restricted to certain doctors and hospitals... with the insurance company calling the shots about treatment. You could be subject to horrendous co-pays particularly for outpatient services and treatments. Now I know some people are perfectly happy with their HMO... but for me.. the cost savings and extra perks (silver sneakers) is not worth giving up Medicare and the freedom Medicare provides.
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Having worked in Case Management in a Hospital.. I have personally had to go to a patient's family and tell them that their 80 year old mother could not have her broken hip fixed at our hospital because her HMO wanted her transferred to another one many miles away. They were shocked and said.. "But she has Medicare!!" No... not really.. She has a Medicare Advantage plan and she signed away her traditional Medicare.. So Mom had to be loaded into an ambulance with a broken hip and moved. OR pay for her surgery herself.
 
Hoot N Annie said:
Most folks will know this as an "Advantage" plan
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same here . my wife went medicare and high deductible f-plan . perhaps if we had access to the kaiser plans in our location i might have considered it but advantage plans are cheaper for a reason and the ones we have available stink ..

my buddy bragged about how little his advantage plan cost him .

when his wife got breast cancer towards the end of the year and his out of pocket for chemo was 4500.00 a year he got whacked for 9k .
 
We have Medicare A. In January when I am no longer covered by my Employer, we will have Part B... plus Blue Cross plan F Looking for a Part D plan. And Yes.. I have an affidavit from my Employer stating I have had insurance coverage in order to avoid a Part B penalty since I did not take Part B at age 65.
 
I just wonder just how many people delay retirement only because of the health care premiums they will have to pay before being eligible for medicare when they have to pay 100 percent of that premium? I was talking to someone who's last day of work was on a Friday. I asked him when he would turn 65 and his reply was tomorrow.
 
QuickSilver, were you trying to make a point in one sentence of just how complicated the process can be?
 
We have to be so careful what we chose when it comes to healthcare. I have to select this month and it is making me terribly anxious, but choice is very important to me. It will cost more but I have gone to my PC doc for a number of years and the specialists I see are the ones that have helped me the most. Changing now would not be good. I don't want to see a dr I know nothing about, I already have had a recommendation for radical surgery that I questioned. Seeking another dr outside my area, that surgery was replaced with a procedure! So, there is a huge difference in Drs, especially from the smaller hospitals as opposed to the larger ones. They see more patients and have more experience. They are more current with new procedures which can be a very big deal. Saving money is great and for some, the only way they can afford it at all. I just don't want to be be tricked into purchasing healthcare that takes my choices away.
 
Turning 65 and Medicare - disclosure..this does promote my agency. If you want our help great, if not, please use the information to help you understand what your options are and find someone to compare all the plans and companies for you. I am very passionate about this subject....

I usually send this to my clients who are starting Medicare. I have several hundred clients on Medicare and I can tell you I recommend Original Medicare (Part A and Part B) with a supplement plan (Plan G) and a Part D plan from medicines.

Here is a chart I send to clients who ask about MA plans:


"SilverSneaker is a benefit on some Medicare Advantage (MA) plans. MA plans seem great until you use them. They have VERY high out of pocket exposure as compared to a medicare supplement plan G. With a medicare supplement plan G, you have a $166 deductible for medical expenses. That’s the most you will pay for doctor visits or hospital stays. With a MA plan, you have a max out of pocket (MOOP) from $5,000 (typical for HMO plans) to $10,000 (typical for PPO plans) per year depending on the plan type. That’s a LOT of risk to take on for a free gym membership!


Medicare Supplements
Medicare Advantage Plans
A 6+ day stay at hospital
You pay $0
You pay $1,500-2,200

Chemotherapy
You pay $0
You pay 20% up to max out of pocket (MOOP)

Lab work
You pay the first $166 (part B deductible) per year, then $0 afterwards.You pay 20%
Doctor visits
You pay the first $166 (part B deductible) per year, then $0 afterwards.
You pay a copay every time you see your doctor and more for specialists.

Networks
You can choose your doctor or hospital anywhere in the country
You have to stay in a HMO network or pay more to be outside a PPO network.

Max out of pocket (MOOP) for Doctors and Hospitals per year
$166 (part B deductible)
$5,000+ with HMO networks
Up to $10,000 with PPO networks

Dental/Vision
None
You get a checkup once a year

Gym membership
None
You get a Free gym membership

What clients want
People want to be on these plans when they get sick.
People want off of these plans when they get sick.

MA plans are great when people don’t have claims. When they get sick, MA plans are no fun! Lots of bills. I get calls all year long from people on MA plans desperate to get off them. Every one of them are sick and the out of pocket exposure is killing them. Problem is once you have major claims (like what these people who call me are having), it’s very difficult to impossible to move them to a medicare supplement. Medicare supplement are going to ask health questions and since they are on claim, they will not get approved.

Like what was described above, get sick in November or December and have treatment roll over to the next year...guess what...new year and your out of pocket exposure resets.

I try to show all my clients that Medicare supplements are a better choice. Most understand why, but some want the lower cost initially. I have had several comeback desperate to get off after getting sick, but there was little we could do then. Those conversations are never fun. I have had enough of them and that’s why I try to convince my clients that medicare supplement plans are the best for them long term.

On the other hand, I have had clients who get diagnosed with cancer and love how well their medicare supplement plan takes care of the doctors and hospital bills. They can focus on getting better and not have to deal with the stress of paying these big bills that would happen if they were on a MA plan. I have NEVER had a phone call from a client upset with me on what their medicare supplement did not pay…never."

I hope that helps people understand the difference. People often forget about how much exposure they have on an MA plan until it's too late.
Thanks
Rusty
 
we have silver sneakers as part of our humana high deductible f-plan . they pay the gym directly . it cost me 480 a year for myself at the gym so silver sneakers is worth a lot of money and is part of some medicare supplements . .we pay 90 a month for the supplement . i pay 40 a month alone for my gym .
 
I'm on an advantage plan and I couldn't be happier. My plan is tied to the largest and best hospital here, and practically all the physicians in Albuquerque accept it. I don't pay anything in addition to my $106 (or whatever it is now) Medicare premium.

When I had BOTH my hips replaced almost 3 years ago, I paid almost nothing -- my hospital was about $400 (that's for both surgeries, done a month apart), my orthopedic surgeon cost me $50 out of pocket (I only had to pay for the initial visit, nothing else for subsequent visits, or the surgeries themselves). Diagnostic and pre-op tests cost me nothing. Followup and home PT cost me nothing. I got wonderful care at the hospital and had a private room.

I was able to choose my surgeon out of the large pool of physicians, and got the one I wanted, who happens to be one of the best (arguably THE best) here for hip and knee replacements. He's board certified and practices with the biggest and best orthopedic group here.

I am super satisfied with my advantage plan.

When I dislocated my shoulder a year or so ago, I paid a total of $50 to the ER, nothing for physicians, x-rays, or meds (thank God for morphine), and again got wonderful care.
 
the problem is with advantage plans it is hit and miss . like i said , kaiser has some excellent plans but we have none available to us . with supplements you know your exposure . with advantage plans they are a lot more complex and as many like my friend found out have exposure's you are not aware of until you hit them .

the old saying , nothing is a problem until it is a problem can be very true with many advantage plans
 
I'm sure that same old saying could apply to many supplements, as well. With my plan, I know exactly what my exposure is. If I have a question about that, I can either look it up, or, better yet, call the administrator's office and talk to a real, live, human, who also is here, not in India. Good Rx benefits, too.

Having said that, the plan I'm on is a local one and only available in New Mexico.
 
that is the other draw back , we travel and most advantage plans can give you grief outside your area except for what they consider the extreme emergency's . supplements are very tightly controlled unlike advantage plans .

advantage plans are no different than regular hmo's . they can decide what they will pay for ,what they will argue and limit .

supplements can not . as long as medicare covers the expense they are bound by law to cover and pay what medicare does not .

don't forget with an advantage plan ,what gets counted towards an out of pocket is based on what they will pay . you can spend money for something and they can feel they won't cover it and the dollars don't count .

after our agreed deductible we have zero holes . if we took the full f-plan instead of high deductible than that is it . we know there will be not another penny for anything paid out by us .
 
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if you are healthy a high deductible f-plan is well worth it . we pay 2k a year less for it than an f-plan . at best we spend about 400-500 in deductibles . remember it covers only what medicare does not . it is based on medicare prices too .

so if an mri is 2k , medicare may only allow them 500 bucks .so they pay 80% of 500 and your whole deal is 100 bucks . more often than not the deductibles are under 10 bucks so it is hard to come up with 2k in uncovered stuff . even if you do you are no worse off since you saved 2k on premium.
only humana offered it in nyc where we are
 
To me.. Purchasing a High Deductible plan or a Medicare HMO is akin to gambling... You are gambling you will stay healthy and won't be hit with huge OOP expenses... or that you will not need a Specialist or hospital outside your plan. I'm just not willing to take that chance to save a few bucks every month. It's not worth it to me.
 
QuickSilver said:
To me.. Purchasing a High Deductible plan or a Medicare HMO is akin to gambling... You are gambling you will stay healthy and won't be hit with huge OOP expenses... or that you will not need a Specialist or hospital outside your plan. I'm just not willing to take that chance to save a few bucks every month. It's not worth it to me.
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a medicare hmo is really an advantage plan , but medicare and a high deductible supplement are something else .


the high deductible f-plan is the same 2k spread . the full f-plan costs 2k more . the high deductible f-plan is 1k and a 2k deductible .

exposure in both cases is the same only we have been saving more than 1500 a year because we don't come close to 2k in un-reimbursed medical . remember you are only dealing with what medicare does not cover fully
 

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