My Retiree Medicare Supplement Plan Expires on December 31, 2015

L

Lon

Well-known Member
Location
Central California
I just finalized enrolling in a new Drug Plan and Medicare Supplement Plan which becomes effective on January 1, 2016.The Drug Plan will cost $24.80 monthly and the Medicare Supplement Plan will cost $233.50 monthly.The premiums will be paid each month from my HRA (Health Reimbursement Account). The Drug Plan has a modest co-pay and the Medical Plan has no deductibles, co-pays or max out of pocket. I will have full choice of doctors etc and will be able to continue with my present doctors.
 

Lon said:
I just finalized enrolling in a new Drug Plan and Medicare Supplement Plan which becomes effective on January 1, 2016.The Drug Plan will cost $24.80 monthly and the Medicare Supplement Plan will cost $233.50 monthly.The premiums will be paid each month from my HRA (Health Reimbursement Account). The Drug Plan has a modest co-pay and the Medical Plan has no deductibles, co-pays or max out of pocket. I will have full choice of doctors etc and will be able to continue with my present doctors.
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Similar to mine.. i have United Heath Care Drug plan and Mutual Of Omaha supplement..Have had the supplement since 2009 and have never paid a dime for hospital stays (4) and Doctor visits..woohoo1.gif
 
So long as you have traditional Medicare and a supplement... you never will have to pay a red cent for Hospital stays. The Co-pay for inpatient hospital stays is picked up by your supplement.
 

In 2011 having Medicare A&B along with a supplement plan with UnitedHealthCare through AARP and a drug plan I was hospitalized with subsequent surgery in Nov. Then my continued care and followup treatments continued into 2012. I ended up paying just shy of $11,000 because of the out of pocket limit set by my insurance carriers of approx $4,000 for 2011 & 2012. The extra I paid was a result of their creative accounting and out-of-network drugs and treatment options.

Then in 2015 I was hospitalized again at the same hospital but had changed my supplement provider, it also had a drug plan. I paid the hospital $1,300 because my plan had a $3,400 upper limit of out-of-pocket expenses. I paid the $320 deductible for drugs and along with co-pays amounting to just over $350 I entered the doughnut hole and was hit with the $800 expense for my next 3 month prescription refill which I only afford & paid $269 for one month. Both my Primary Care facility and the hospital said they refuse to accept patients without a supplemental plan to Medicare. I must have missed the gravy train and somehow missed the pie-in-the-sky plans you are talking about.

I'm learning the game slowly and will be discussing my treatment options today with my PCP to reduce my costs for medication & supplies but thought I had the most affordable and adequate coverage offered. I guess if I had paid the additional $250-300 monthly for the higher priced supplements then over the course of 4 years and coverage costs of $3,000 - $3,600 would have offset the $12,500 I had paid out of pocket. $12,000 - 14,400 (extra premiums) looks like a wash to me, but life is a gamble. The only ones who will win are those that opt for the lower plan and stay healthy.
 
I have Medicare A,B and D and a supplement policy...go every 6 months for checkup, have all my annual test ran, was in the hospital for 3 days and recently had cataract surgery...the only thing I've paid out of pocket was for prescription of eye drops and that was only partial.
 
Jackie22 said:
I have Medicare A,B and D and a supplement policy...go every 6 months for checkup, have all my annual test ran, was in the hospital for 3 days and recently had cataract surgery...the only thing I've paid out of pocket was for prescription of eye drops and that was only partial.
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Looks like you and Ken live in the right state (Texas), I spent 2 hours on the phone with our supplemental provider and she explained in laymen's terms what they and all supplement plans provide in our state. Our provider has a 5 star rating in my home state and has the highest rated customer satisfaction of all the plans. I questioned her about the drug plans tiers and how much they cover from top to bottom. Why I was paying for out of network services that was provided for me. What pharmacies are preferred. What I will pay for the insulin I was prescribed because it was too new to have a generic replacement. Why I was paying the additional to the hospital for my stay. What is my best optional plan, I finished the call with a better understanding, but not very darn satisfied.
 
Son_of_Perdition said:
Looks like you and Ken live in the right state (Texas), I spent 2 hours on the phone with our supplemental provider and she explained in laymen's terms what they and all supplement plans provide in our state. Our provider has a 5 star rating in my home state and has the highest rated customer satisfaction of all the plans. I questioned her about the drug plans tiers and how much they cover from top to bottom. Why I was paying for out of network services that was provided for me. What pharmacies are preferred. What I will pay for the insulin I was prescribed because it was too new to have a generic replacement. Why I was paying the additional to the hospital for my stay. What is my best optional plan, I finished the call with a better understanding, but not very darn satisfied.
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Sorry you're having problems, just keep asking around, maybe compare with other Seniors, hope it works out for you.
 
Ken N Tx said:
Similar to mine.. i have United Heath Care Drug plan and Mutual Of Omaha supplement..Have had the supplement since 2009 and have never paid a dime for hospital stays (4) and Doctor visits..View attachment 24022
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We've had mutual of Omaha Supplemental since going on Medicare. It has gone up over the years but we never have any out of pocket to pay. Good Company.
 
AZ Jim said:
We've had mutual of Omaha Supplemental since going on Medicare. It has gone up over the years but we never have any out of pocket to pay. Good Company.
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The problem I have seen with patients is that many believe they have Medicare, when in reality they have a Medicare Advantage plan.. The problem with Medicare Advantage is that it is an HMO run by a private insurance company.. and usually have large out of pocket expenses for hospitalization.

Again.. for an inpatient hospital stay you will NEVER have to pay the hospital a dime provided you have a supplement that will pick up the $1,280 deductible Medicare charges. Your hospital bill can be hundreds of thousands.. and you will NOT have to pay one penny of it.
 
QuickSilver said:
The problem I have seen with patients is that many believe they have Medicare, when in reality they have a Medicare Advantage plan.. The problem with Medicare Advantage is that it is an HMO run by a private insurance company.. and usually have large out of pocket expenses for hospitalization.

Again.. for an inpatient hospital stay you will NEVER have to pay the hospital a dime provided you have a supplement that will pick up the $1,280 deductible Medicare charges. Your hospital bill can be hundreds of thousands.. and you will NOT have to pay one penny of it.
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I had a triple bypass in an emergency surgery after a doctor put me in a helicopter and flew me to a heart hospital in Vegas (I had a choice of Vegas or Phoenix), many allied services and paid, as you said, not one penny.
 
AZ Jim said:
I had a triple bypass in an emergency surgery after a doctor put me in a helicopter and flew me to a heart hospital in Vegas (I had a choice of Vegas or Phoenix), many allied services and paid, as you said, not one penny.
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This is because of how Medicare pays.. It pays by a system called MS-DRG... (Medical severity- Diagnostic Related Groups). Simplistically put. Medicare puts a value on each diagnosis. A Medicare patient is assigned ONE diagnosis based on what symptoms and condition got him admitted to the hospital.

Let's look at Jim's diagnosis.. His Medical diagnosis was Coronary Artery disease.. or CAD.. His Surgical Procedure was tripple bypass. Medicare told Jim's hospital OK... we are going to pay for Jim's bypass.. And we are going to pay you $XX,000. and that's it.. that's what you get for treating Jim. we don't care if he is in 5 days or 55 days.... You get $XX,000. so you better do your very best to get Jim all fixed and well in the shortest amount of time or you are going to lose money.. Hospitals who agree to be Medicare providers have agreed to accept what Medicare pays and to NOT charge the patient the difference. If Medicare pays $XX.000 and it costs the hospital $XXX,000. the hospital is going write off the difference.

Hospitals are happy to do that as, for one thing.. their charge systems are not really based in reality.. and Medicare is a really HUGE chunk of their payer base.


When someone opts for a Medicare Advantage plan.. they are opting for a private insurance HMO. Private insurance companies as a rule do NOT use the MS-DRG system... They are most times set up a Maximum out of pocket schedule.. Sometimes as high as $10,000. So the patient is on the hook for up to that much... Not a really good deal IMO.
 
QuickSilver said:
The problem I have seen with patients is that many believe they have Medicare, when in reality they have a Medicare Advantage plan.. The problem with Medicare Advantage is that it is an HMO run by a private insurance company.. and usually have large out of pocket expenses for hospitalization.

Again.. for an inpatient hospital stay you will NEVER have to pay the hospital a dime provided you have a supplement that will pick up the $1,280 deductible Medicare charges. Your hospital bill can be hundreds of thousands.. and you will NOT have to pay one penny of it.
Click to expand...


I have a Medicare Advantage plan through a large local hospital and its physician group (and others who accept the plan). Most doctors here in Albuquerque do accept the plan. I paid about $1,000 for TWO hip replacement surgeries and hospitalizations, my surgeon, anesthesiologists, tests, etc. That's all together. One drug, an anticoagulant called Xarelto, had a higher co-pay. The rest were all covered.

Medicare Advantage plans are not all alike.
 
what about PPO advantage plans?

QuickSilver said:
When someone opts for a Medicare Advantage plan.. they are opting for a private insurance HMO. Private insurance companies as a rule do NOT use the MS-DRG system... They are most times set up a Maximum out of pocket schedule.. Sometimes as high as $10,000. So the patient is on the hook for up to that much... Not a really good deal IMO.
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I'm new here and reading so far, it seems that people aren't aware of the Medicare Advantage PPO plans which also have networks but aren't, I think, as "strict" as HMOs. I'm a retiree in a state public employees Humana Medicare Advantage plan that has been outstanding but alas, too expensive. So they're ending it, giving us a monthly allowance and we have to choose a new plan for ourselves. It's been extremely stressful. I was going to go with an advantage PPO plan but then saw the $200 copay per day for first 6 days in hospital and backed off. I was in the hospital 3 times last year and the plan we have now took care of most of it but the advantage plans to choose from now aren't nearly that good.

I was pretty ready to pick an F plan and then saw a post on another thread about F going away by 2020, or at least no new enrollments so it may be a G now.

The hospital system and doctors I've been using notified us that they are only accepting advantage plans from 2 companies but any medigap plan. That also swayed my decision!
 
Last edited:
Hi SOP - if your plan included(s) a prescription drug benefit then it is a Medicare "Advantage" plan not a Medicare "Supplement" Plan. Only advantage plans include drug coverage and the product United Health Care provides through AARP is an Advantage Plan. I am in Medicare Insurance so I deal with this info. daily.

There are only (2) types of plan options when you buy insurance in addition to what you have with Medicare Parts A and B. The one is an "Advantage" plan and the other is a "Supplement". Each are sold by most of the big insurance companies.

Advantage plans are "cheaper" (lower monthly premium) but unfortunately what happened to you is the bad part about Advantage plans. The bad part about advantage plans are the "limitations" which are in-network doctors and limits on the procedures and coverage amounts for each procedure.

The "Supplement" plans cost a little more monthly but they cover everything that is approved by Medicare at any doctor anywhere who accepts Medicare, no networks.

In my experience the Advantage Plans cost around the $90-100/month, and some are even advertised by the companies as "zero premium" but if you are paying nothing on the front end you sure as heck better understand what the cost is going to be on the back end when you need to use it.

The "Supplement" plans usually cost $150-$200/month but that is your only expense, you won't run into the denial of coverage and the high cost of procedures that you did. Sorry that happened to you, I'm sure it was not something you expected could happen when you bought the UHC/AARP plan.

There are two times that you can switch out of your Advantage plan back into regular medicare and the purchase a supplement plan. The first is if you are still in your initial 12 months of owning your advantage plan, they call this a trial period and you can cancel it at any time (this doesn't sound like you). The second time is the annual Medicare Advantage disenrollment period which is each year from January 1 - February 14.

Son_of_Perdition said:
In 2011 having Medicare A&B along with a supplement plan with UnitedHealthCare through AARP and a drug plan I was hospitalized with subsequent surgery in Nov. Then my continued care and followup treatments continued into 2012. I ended up paying just shy of $11,000 because of the out of pocket limit set by my insurance carriers of approx $4,000 for 2011 & 2012. The extra I paid was a result of their creative accounting and out-of-network drugs and treatment options.

Then in 2015 I was hospitalized again at the same hospital but had changed my supplement provider, it also had a drug plan. I paid the hospital $1,300 because my plan had a $3,400 upper limit of out-of-pocket expenses. I paid the $320 deductible for drugs and along with co-pays amounting to just over $350 I entered the doughnut hole and was hit with the $800 expense for my next 3 month prescription refill which I only afford & paid $269 for one month. Both my Primary Care facility and the hospital said they refuse to accept patients without a supplemental plan to Medicare. I must have missed the gravy train and somehow missed the pie-in-the-sky plans you are talking about.

I'm learning the game slowly and will be discussing my treatment options today with my PCP to reduce my costs for medication & supplies but thought I had the most affordable and adequate coverage offered. I guess if I had paid the additional $250-300 monthly for the higher priced supplements then over the course of 4 years and coverage costs of $3,000 - $3,600 would have offset the $12,500 I had paid out of pocket. $12,000 - 14,400 (extra premiums) looks like a wash to me, but life is a gamble. The only ones who will win are those that opt for the lower plan and stay healthy.
Click to expand...
 
Another thing that I will add is that you MUST take out a drug plan at age 65 or YOU WILL PAY A PENALTY if you wait until a later age!!!!
 
Ken N Tx said:
Another thing that I will add is that you MUST take out a drug plan at age 65 or YOU WILL PAY A PENALTY if you wait until a later age!!!!
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Even if you haven't retired and are still taking your employers Group insurance? Why would I pay for a drug plan when one is included in my benefit package? I'm not taking Medicare part B either... I'm 67
 
QuickSilver said:
Even if you haven't retired and are still taking your employers Group insurance? Why would I pay for a drug plan when one is included in my benefit package? I'm not taking Medicare part B either... I'm 67
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I believe (please check) that if you have a plan it will be good until you retire..
 
QuickSilver said:
Even if you haven't retired and are still taking your employers Group insurance? Why would I pay for a drug plan when one is included in my benefit package? I'm not taking Medicare part B either... I'm 67
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Your present insurer will send you a letter each year stating that your drug plan meets the requirements necessary so that you *won't* have to pay a penalty if/when you decide to switch to a Part D drug plan.
 
Ken N Tx said:
Another thing that I will add is that you MUST take out a drug plan at age 65 or YOU WILL PAY A PENALTY if you wait until a later age!!!!
Click to expand...

That's right Ken. In "general" it is a 1% penalty per month that you wait to enroll beyond your initial enrollment window. So if you are one month late it would be an additional 1% added on to your premium, 10 months late = 10% and so on. Here's how it is explained on Medicare.gov (https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html)
 
JLach08 said:
That's right Ken. In "general" it is a 1% penalty per month that you wait to enroll beyond your initial enrollment window. So if you are one month late it would be an additional 1% added on to your premium, 10 months late = 10% and so on. Here's how it is explained on Medicare.gov (https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html)
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Yes, I know as I paid the penalty!! No one ever explained that I must sign up for a drug plan at 65!! I was/am in good health and never take any drugs so I "thought" that I did not need the coverage!! Was I wrong!!00000060.gif
 
Son_of_Perdition said:
In 2011 having Medicare A&B along with a supplement plan with UnitedHealthCare through AARP and a drug plan I was hospitalized with subsequent surgery in Nov. Then my continued care and followup treatments continued into 2012. I ended up paying just shy of $11,000 because of the out of pocket limit set by my insurance carriers of approx $4,000 for 2011 & 2012. The extra I paid was a result of their creative accounting and out-of-network drugs and treatment options.

Then in 2015 I was hospitalized again at the same hospital but had changed my supplement provider, it also had a drug plan. I paid the hospital $1,300 because my plan had a $3,400 upper limit of out-of-pocket expenses. I paid the $320 deductible for drugs and along with co-pays amounting to just over $350 I entered the doughnut hole and was hit with the $800 expense for my next 3 month prescription refill which I only afford & paid $269 for one month. Both my Primary Care facility and the hospital said they refuse to accept patients without a supplemental plan to Medicare. I must have missed the gravy train and somehow missed the pie-in-the-sky plans you are talking about.

I'm learning the game slowly and will be discussing my treatment options today with my PCP to reduce my costs for medication & supplies but thought I had the most affordable and adequate coverage offered. I guess if I had paid the additional $250-300 monthly for the higher priced supplements then over the course of 4 years and coverage costs of $3,000 - $3,600 would have offset the $12,500 I had paid out of pocket. $12,000 - 14,400 (extra premiums) looks like a wash to me, but life is a gamble. The only ones who will win are those that opt for the lower plan and stay healthy.
Click to expand...

You have a Medicare Advantage Plan not a Supplrment.
 
If a Advantage Plan has lower premiums or no premium it probably is an HMO, which usually have stronger benefits.



JLach08 said:
Hi SOP - if your plan included(s) a prescription drug benefit then it is a Medicare "Advantage" plan not a Medicare "Supplement" Plan. Only advantage plans include drug coverage and the product United Health Care provides through AARP is an Advantage Plan. I am in Medicare Insurance so I deal with this info. daily.

There are only (2) types of plan options when you buy insurance in addition to what you have with Medicare Parts A and B. The one is an "Advantage" plan and the other is a "Supplement". Each are sold by most of the big insurance companies.

Advantage plans are "cheaper" (lower monthly premium) but unfortunately what happened to you is the bad part about Advantage plans. The bad part about advantage plans are the "limitations" which are in-network doctors and limits on the procedures and coverage amounts for each procedure.

The "Supplement" plans cost a little more monthly but they cover everything that is approved by Medicare at any doctor anywhere who accepts Medicare, no networks.

In my experience the Advantage Plans cost around the $90-100/month, and some are even advertised by the companies as "zero premium" but if you are paying nothing on the front end you sure as heck better understand what the cost is going to be on the back end when you need to use it.

The "Supplement" plans usually cost $150-$200/month but that is your only expense, you won't run into the denial of coverage and the high cost of procedures that you did. Sorry that happened to you, I'm sure it was not something you expected could happen when you bought the UHC/AARP plan.

There are two times that you can switch out of your Advantage plan back into regular medicare and the purchase a supplement plan. The first is if you are still in your initial 12 months of owning your advantage plan, they call this a trial period and you can cancel it at any time (this doesn't sound like you). The second time is the annual Medicare Advantage disenrollment period which is each year from January 1 - February 14.
Click to expand...
 

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