OT: Medicare Advantage Plans

[Sheriff Buford]

Thanks,

Sheriff

[Pugsy]

My wife would totally make fun of me right now if she knew I was on here talking about insurance.

You never know when you get to talk shop do you. Mostly I do cpap stuff here but on occasion I will diverse a bit. Sheriff and I are old friends so I wanted to try to help him figure out which way to go with this new wrinkle he has to learn about.

I used to have the UHC advantage plan...man they annoyed me to no end with their waiting times for procedures. I didn't need many but when I needed them I didn't like having to wait 3 weeks from the time the doctor said I needed it to when I could get it done. Not to mention one of the medications I take was a tier 3 ($36 a month) with them and had a 150 dollar deductible to boot. Geezzz...so when I got the chance to change that is what I did...lowered my monthly premium to 0 (was 29 I think it was going to)...lowered my surgery center co pay from 250 to 200...lowered my medication cost to $3 a month (no deductible) for that medication that was tier 3 on the UHC plan...and if the doctor says I need a procedure done tomorrow and I want it done tomorrow......there is no waiting. Oh...and my max out of pocket limit was cut by a third. I am a happy camper.
Now it is a half assed HMO kind of thing but I am okay with that. The chances of my ever going out of network are slim and none. I rarely travel and even if I did and something happened...it's not like I am totally on my own. There is coverage for emergency situations and no one in network is nearby.

People should learn what Medicare covers and does not cover anyway...just so they know what to expect. Then they can decide how much risk they want to take or not. Back when I went on Medicare there was only one company selling a medigap supplement to under 65 people and it cost an arm and a leg. Let's face it...insurance companies didn't want the risk. I waited 4 years to get an advantage plan and just paid my PartB deductible and 20% for the handful of expenses I had. I think most years I didn't even meet the Part B deductible. Then sleep apnea reared its ugly head and I pretty much knew I was going to need a cpap and a sleep study and all that stuff. I beat feet to get some sort of coverage to limit my out of pocket expenses that I knew were in my future. I got an advantage plan on the last day of open enrollment.

I worked as sort of a physician's assistant prior to selling insurance for probably 30 years...bad car wreck and broken back and a bunch of other stuff took me off the floor and I need a profession where I could dictate how much time I worked and/or was on my feet...hence the change to selling insurance.
So here I am back to sort of working in the medical field again but mainly just helping with apnea and cpap stuff...and occasionally throwing in some insurance tidbits.
Retired and volunteering here....keeps my brain busy anyway. Lots of medical knowledge in my background that I draw upon quite often...and as you know people who work in the medical field do it because they want to help people...and my being here is my way of continuing to help people. I suppose the selling of insurance was also a way of helping people as well. Must be in my blood.

[atab]

I think Pugsy is right on the spot. You have to study insurances: Medicare, Medicare with supplements and Medicare Advantage. Decide the amount of risk you are willing to take. Do the math: probabilities and worst case. Then take an informed decision.

Until last year I was on company insurance. They offer 6 x 4 plans. That is 6 plans and each plan from 4 companies. I wrote a Python program and plotted graphs. It turned out the most expensive plan customers always pay more, regardless of amount of medical expenses. Annual pay check deduction for expensive plans exceeds out of pocket maximum of cheap plans. But many people get the expensive plans.

atab

[Sheriff Buford]

The wife has an HMO. A few years back, she had knee problems. The Orthopedic said "I'm going to end up replacing your knee", but the HMO insisted on three separate surgeries to prevent a knee replacement. Well, they ended up replacing the knee anyway.... just as the doctor stated. She was also on Humira for her arthritis. The HMO sent us a letter saying the medicine was too expensive. So, the doctor had to prescribe a different medicine. The point I'm making is that it is frustrating that a person behind a desk is calling the shots. I can see where an HMO style plan is great for the pocketbook and for a fairly healthy person, my gut tells me that my health is going to go south, and quickly. I'm leaning towards the supplement, but I wanna make sure I have full knowledge of the Advantage plans. I want an agent to give the straight scoop on both plans. Dang... why does this have to be so hard?

Sheriff

[Pugsy]

The hard part is finding an agent who cares about you and what you need over their commission check. There are agents like that out there but it's sort of like finding a DME who thinks about you first and not their profit margin....not always easy to find. They are worth their weight in gold when you do find them though.

Not all advantage plans are HMOs. Some are PPOs and some it doesn't matter who you see.

If it worries you about the "what ifs" that might happen and what you might have happen down the road...get the plan G and a part D medication plan. Learn what Medicare covers or doesn't cover...you need to be aware of that anyway no matter what you get because for the most part the advantage plans are tied to medicare allowable. The little extras that some advantage plans offer...the fluff as I call it...not that big of a deal in terms of what they "give" you.
Then you know you pay X amount of dollars every month and the big things are covered. As long as Medicare pays...the supplement will pay. If Medicare doesn't pay...the supplement won't pay. That's why you need to know what Medicare allows and doesn't allow.

The medication part D plans...I don't know much about them since it has been so long since I have had one but remember Medicare doesn't pay for medications that you take yourself. So the plan G supplement won't either. It won't pay any deductibles or copays for your medications. The medication supplement part D plan is totally different and separate from Medicare and your Plan G. Think of it as 2 totally different plans that aren't tied together at all.

With the Plan G...you pay X amount of dollars and any Part A hospital out of pocket that you might owe....it will pay for you.
For the Part B....after the annual deductible that you have to incur before Medicare starts paying 80% the plan G will start paying the 20% that you owe. You end up paying your premium each month and that Part B deductible and that's all you ever pay for any Medicare allowed expenses.

Always stay with providers that accept Medicare assignment which means they are happy with what Medicare says they should be happy with. Most DMEs will but doctors don't have to accept assignment if they don't want to. Pretty much all hospitals accept assignment...it's their bread and butter cash cow. Doctors on the other hand...sometimes they don't like what medicare says they should be happy with because it isn't as much as they won't. Always ask if they accept assignment or not. Some doctors just won't even accept Medicare patients at all because even if they don't accept assignment they are limited to what they can charge Medicare patients.
I think the Plan G picks up the gap between what medicare approves and what doctors are allowed to charge above the allowed amount but most doctors will take assignment if they take a medicare patient. They get paid faster and they know how much they get paid.

As time goes by and you get a better handle on things and look at how much you use your supplement you can always change during next years open enrollment if you wish to (subject to any medical underwriting that your state may or may not allow).....but if you like the idea of just paying the monthly premium and not worrying about anything or having an HMO dictate who you see or what you do....get the Plan G.
Now do understand that Medicare itself requires pre approval for some procedures. When a doctor says "you need a hip replacement" he has to get Medicare approval first. The doctors know this and its not unexpected. Usually not a big deal...not like it is with HMOs and those sort of companies.

[atab]

Sheriff,

Whether you have a HMO or PPO, the insurance might not approve (or try not to approve) some surgeries. Each plan has what it covers and conditions for approval. Unfortunately we don't usually find out about them until too late. I have found some insurance providers are trickier than others. HMO means the providers must be in plan's network.

atab

[khauser]

(Planning when I need to sort through this...)

Why don't we start CPAPTALKInsurance.com, and employ Pugsy!

[Pugsy]

(Planning when I need to sort through this...)

Why don't we start CPAPTALKInsurance.com, and employ Pugsy!

No, no, no and hell no. I am not going down that road again. I have more on my plate now than I can handle.
Aint't gonna happen as they say in my neck of the woods. Way too many rules and regulations and they can vary widely and then they can change every year besides varying. You all couldn't pay me enough to do it. No way in hell.

[khauser]

(Planning when I need to sort through this...)

Why don't we start CPAPTALKInsurance.com, and employ Pugsy!

No, no, no and hell no. I am not going down that road again. I have more on my plate now than I can handle.
Aint't gonna happen as they say in my neck of the woods. Way too many rules and regulations and they can vary widely and then they can change every year besides varying. You all couldn't pay me enough to do it. No way in hell.

I need sad puppy dog emoji...

[prodigyplace]

(Planning when I need to sort through this...)

Why don't we start CPAPTALKInsurance.com, and employ Pugsy!

No, no, no and hell no. I am not going down that road again. I have more on my plate now than I can handle.
Aint't gonna happen as they say in my neck of the woods. Way too many rules and regulations and they can vary widely and then they can change every year besides varying. You all couldn't pay me enough to do it. No way in hell.

I need sad puppy dog emoji...

Sad Little Pug.png

[khauser]

I just realized Pugsy may have been pre-conditioned to ignoring sad puppy dog eyes, given her profile pic....

[zonker]

(Planning when I need to sort through this...)

Why don't we start CPAPTALKInsurance.com, and employ Pugsy!

No, no, no and hell no. I am not going down that road again. I have more on my plate now than I can handle.
Aint't gonna happen as they say in my neck of the woods. Way too many rules and regulations and they can vary widely and then they can change every year besides varying. You all couldn't pay me enough to do it. No way in hell.

so, you aren't really SURE about this?

[Pugsy]

I just realized Pugsy may have been pre-conditioned to ignoring sad puppy dog eyes, given her profile pic....

My avatar is Sarge...he was my little buddy...crossed over the Rainbow bridge about a year and a half ago...We had 9 years together...I rescued him because no one wanted him because he had a little bit of white on him. He loved me to death. Followed me everywhere.

So now I get to see this little face every day...and this isn't her best "woe is me face"...she has one that is the most pitiful sad face a person can imagine but I haven't been able to get the camera fast enough to catch it. She gives it to my husband often when he quits petting her and she's not ready for him to stop. Meet Lucy.. She's also a rescue situation and has packed on some pounds since this picture was taken. She's on a diet right now. I get the "woe is me look" every time I put her food in front of her and it's not as much as she wants.

So .......sad puppy dog eyes won't cause me to change my mind. I am quite used to "the look".

[khauser]

Sarge and Lucy are both adorable. I'm sad that Sarge has left your world.

Rescue's are great. We have to rescue cats, and a rescue bird (different parts of the house, LOL) along with a bird that was bought at a store.

Rescue's do come with their problems, don't they?!

[Pugsy]

Rescue's do come with their problems, don't they?!

They do indeed but then that's what makes them even more precious and a joy to be around. All but one of my cats are "dumps" and the one that I actually was a rehome for her...she's crazier than a bat so I guess that qualifies as rescue as well. She wasn't working out in her first home. She's a Bengal...man when she gets pissed she screams at me and it sounds like I have a mountain lion in my house and she cusses me out frequently.

Lucy is a lover...loves everyone and has the "woe is me" look down pat.

Here's another one of my rescues...Toby...I got him about 10 years ago to be a buddy for Sarge. From the local animal pound...he was on the short list to be shot because no one wanted him. He's a wuss...terrified of any loud noises...even the washing machine kicking in sends him running and shivering. Thunderstorms...he tries to crawl into my skin.