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Thu Jan 23, 2014, 11:02 AM

Any other soon-to-be 65ers who are stressing about what Medicare plan to buy?

Any old-timers who are already on one who are willing to help me choose?

My husband retires in a few months and I turn 65 in April and we will both be going on Medicare.

I am going nuts trying to figure out what we need..

He has Diabetes, type 2.. I am on nothing (but whenever I get around to going to the DR, I'm sure they will want me on something

I am leaning towards Humana Advantage, but I am so afraid of choosing the wrong one..



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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 11:09 AM

1. I just have A, B, and D.

Like you, I'm not "on" anything or under medical supervision.

I'd select the plan based on which best supports diabetes. And I'd push them about it. It's easy to change plans.

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 11:27 AM

2. I was buried in bullshit and said to hell with them all

The last thing I wanted was some HMO telling me I had to fire some of my doctors because they were not in the network.

HMOs are the big thing in this state. There are few PPO options.

However, I have enough money to cover the difference after Medicare A&B. My way isn't for everybody.

Medicare Advantage and the other HMOs are fine for people who are not yet seriously ill. They do a good job there. They're just not so great for those of us halfway through the stretch in the gimp race who have cobbled together a list of docs in different plans.

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Response to Warpy (Reply #2)

Thu Jan 23, 2014, 11:50 AM

7. Problem for most people is without an Advantage Plan or supplement, there is no max out-of-pocket.

I think that is the biggest problem with traditional Medicare Parts A and B.

So, if you get cancer or something, you might end up spending every penny you have for coinsurance. Lack of prescription drugs could do the same.

So, I will at a minimum get a supplement and drug coverage, if I can afford it.

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Response to Hoyt (Reply #7)

Thu Jan 23, 2014, 11:55 AM

9. Again, at this point and with my health problems,

if I get cancer, I'll choose palliative treatment, bend over, and kiss my flabby old butt goodbye. My old bod could not withstand a course of chemo.

But that's me and not you. Advantage might work very well for you.

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Response to Warpy (Reply #9)

Thu Jan 23, 2014, 12:33 PM

14. That's true. If I get such a diagnosis, I'm probably going to drive off a high cliff.

Hope that doesn't happen to either of us.

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 11:41 AM

3. My supplemental plan is "F"

and it covers everything. An agent suggested that I go for the advantage plan as I was healthy and wouldn't have many doctor visits and the advantage had eye and dental and wellness care. I may look into that next year. Then the only matter is price and service of the insurance carrier.

All companies use the same plans. Go to medicare.gov (I think) and look at the benefits and co pays of all plans then you are good to go find an insurance company you can stand.

Medicare part A/B is supplied and costs about $100 and comes out of your check. But it leaves 20% uncovered and for that you probably want a supplemental plan and that's what I think you are asking.

good luck and welcome to the land of the insured!

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 11:46 AM

4. When you sign up with an advantage plan, you sign away your Medicare rights and when

you find your plan won't pay for certain doctors or diseases, you can't reenroll in traditional Medicare until the annual enrollment time. My late husband found this out the hard way. It cost him $10,000 out of pocket for that mistake. Also, often the doctors who are approved by the plan, don't actually take the plan. Also, if you travel you may not have coverage if you fall ill.

I have traditional Medicare with a supplement that picks up what Medicare doesn't cover. It's more out of pocket monthly, but I don't have to worry about getting care when and whenever I need it.

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Response to Cleita (Reply #4)

Thu Jan 23, 2014, 11:48 AM

5. What supplemental plan do you have

 

Approx monthly cost,

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Response to beachbum bob (Reply #5)

Thu Jan 23, 2014, 12:00 PM

12. I have AARP .plan F.

Monthly cost varies by age and place you live. I pay $200 a month, but most plans average about $125 a month. It may seem like a lot, but I never have to pay out of pocket for anything no matter how much medical care I need in the year. I mean one year I had to have two MRIs and weeks of physical therapy when I had a series of strokes. I truly believe that my monthly premium have not caught up with those costs so I really pay for peace of mind.

I can also go see a specialist if I want without having to go through my primary care doctor. I have done it in the past when I wasn't satisfied with the solution and treatment from my primary care doctor who still thinks like an HMO gatekeeper. For instance, I had problems breathing through my nose with attending sinus problems. My primary care doctor kept trying to treat me with nose sprays. I went to a nose specialist on my own who did the surgery I need to repair a severely deviated septum. I'm breathing fine now and not a penny out of pocket other than my premiums.


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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 11:49 AM

6. I am 74 and have plain old fashioned Medicare

The advantage program was not around when I reached age 65 so I went right into Medicare which is administered by the government. I purchased a supplemental plan to cover what Medicare did not pay. I am fairly healthy, but my husband has the same coverage as me and he has a lot of health problems (cancer being one of them) and so far we have only had to pay a small amount for some tests that were not covered.

Two of my sisters have Advantage programs, one just got Blue Cross and had to change her doctor and she is having trouble finding doctors who will take her new plan. My other sister enrolled in plain Medicare just like I did and got a supplemental policy.

When I reached age 65, I had to change my primary doctor because the doctor that I went to for so long would not take Medicare. But it ended up being a good move, I like the doctor that I go to now.

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 11:55 AM

8. I'm on regular Medicare with a Blue Cross

Platinum Blue supplemental policy. I like it. It has a very, very large provider list. The cost for the supplement is $109/month. So, that puts my Medicare costs at about $200/month, which I can afford.

Use caution with Medicare Advantage programs. Many of them are HMOs and very limited as to providers. A lot of seniors have found that those HMO plans make accessing specialists very difficult, since the "management" of the HMO tries to minimize their use. Many people switch away from those Advantage plans within a year or two.

It's really up to you, though. You can change plans during the open enrollment period each year, so you're not stuck forever if you get a plan you don't like. Most of the people I know have Medicare plus a supplement, like I do. You can add Part D, as well, to such a plan, if you wish. I think that gives you the most flexibility, but look closely at the providers in your area for any plan you consider.

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 11:56 AM

10. Try this site

OneExchange-- which used to be Extend Health before they expand to cover pre-65s as well-- has been in this business for 8 years. They'll wlak you through your choices, including factoring in each prescription you need, and then present various choice for your zipcode. No cost to you, as they receive a commission on the bakc end, but the representative doesn't know what they commissions will be (so there is no steerage towards a plan).

https://www.oneexchange.com/login?Url=~%2F&ReturnUrl=~%2F

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 11:58 AM

11. understand the difference between Advantage and MEDIGAP.

Medigap plans are mandated by the government to be standard in their coverage, no matter who the carrier is. There's no weaseling. No waffling. They are simply the best. Advantage plans can be largely junk. That's why they are heavily promoted by the carriers.

Many DU-ers have been happy with the Medigap Plan F. Basically everything is covered under it. Your husband's diabetes really mandates a good plan.

Please, please review the Medigap plans, and then choose a carrier.

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 12:15 PM

13. what you need to know

 

about the supplemental insurance is that all A policies are exactly alike. All b's are just like the other b's. All down the line. So you can pick what letter policy suits you best in coverage, then you pick which company to use. For this part go by price, availability etc., Google complaints or reviews on each company you are considering. You may want to choose one that cost an extra 10 bucks but has a great customer support, pays quickly, accepted widely etc.

Just knowing that each policy letter set is the same as the others of that letter cuts down the choices into something easier to deal with and understand.

Good luck.

It's been several years since I went through this for my mom so am hoping it's still the same.

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 12:35 PM

15. Plan F Supplement...$158 monthly ...medicare $104...planD..$45

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Response to SoCalDem (Original post)

Thu Jan 23, 2014, 01:37 PM

16. I Went Through This Same Process Just Last Year As I Was Turning 65......

as I wanted to make sure I understood all my options I paid a consultant $200 to help me through the process. It was the best $200 I've ever spent.

He urged me to stay away from Advantage Plans - because he said the pressure on the insurance companies from ACA will cause them to raise premiums and lower coverage in their Advantage Plans for Medicare aged people.

He advised me to enroll in Medicare - Parts A & B, Purchase a supplemental plan that covers the remaining 20% not covered by Medicare. And purchase a Part D drug plan. As I am only on two drug products now for hypertension and cholesterol - which are generic medications and not too costly - I chose the cheapest Part D plan from a premium perspective.

My supplemental plan is with Humana. It is a Plan F - which is the most extensive supplemental plan out there from a coverage perspective. Note all Supplemental Plan F's are the same from every insurance company. They basically differ only from a premium perspective. I did a lot of due diligence and called up most every insurance company and asked them a series of the same questions. I did this because I wanted to assess their ability to serve me as a customer.

Some of the companies phone representatives weren't very helpful in answering my questions and clearly saw me as a bother. Others - in particular - Humana - was extremely helpful and offered even additional information which ultimately helped me make my decision to go with Humana.

My hypothesis was if a company wasn't able to provide me with good customer service when I was making a purchase decision in choosing a plan - they might not be too helpful or be able to provide me with good customer service after I was a customer of theirs and needed their assistance in any future claims. I made the decision to maybe pay a little higher premium for better customer service.

Note that the Humana Customer Service Representative pointed me to a Plan F Supplemental that they offered that had a bit of an increased premium - but it actually offered a Vision and Dental component. That is the plan I went with. [Note: Before I called each insurance company I visited their websites; reviewed their plans and also visited the medicare.gov website. I encourage you to do the same - as premiums vary from state to state and zipcode to zipcode)

You see I am self employed and was expected to pay (with the latest premium increase at that time if I didn't reach 65 and enroll in Medicare) $3733.00 every two months - just for myself. Note this was through Blue Cross/Blue Shield. Which since I chose them back in 1997 - raised my premiums like clockwork every year. This would have cost me $22,398/year this year.

Enrolling in Medicare with the Plan F supplemental with Humana with Vision/Dental and my Part D - costs me now around $400.00 per month or $4800/per year - which as you can see is a considerable savings over what I would have paid if I didn't turn 65.

So I urge you to do your own due diligence and make your decisions based on what you can afford, your current health status and think about the customer service aspect as well.

I know that some people will say they don't have a supplemental plan. Caution here - if you are relatively healthy - maybe now you don't need a supplemental. The problem is that rainy day - if you wind up with some problems and you don't have a supplemental - you'll wind up having to pay that extra 20% out of your pocket. I looked at it from this perspective - this is insurance. As such I'm willing to pay up front now and not take the risk. If you ultimately have to get a supplemental plan if you develop other health problems - you will have difficulty being able to get a plan then and if you are able to get a plan - the premiums will be excessive.

Another tip for you is to check out the Social Security & Medicare forum here on DU under the Health topic. I think I asked a similar question back when I was going through this process I described above.

It seems like you have enough time to make your decisions. Take your time. Do your due diligence. Take good notes. Develop your own series of questions. Check out the websites of the insurance companies that provide coverage in your area. Visit medicare.gov. Call the companies - ask questions. Think about customer service. Then make an informed decision.

It appears that you are approaching this the right way - just by your asking the question in your Original Post.

Good Luck!!!!!!


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