In a few months, I'll be eligible for Medicare, so I am starting to look at the options, not only within the Medicare program, but then there are also the Medicare Supplement programs, Medicare Advantage, and perhaps some others. Some of you have already enrolled, while others are probably still in the process of making decisions, so I thought it might be useful to discuss the pros and cons of the various options here. Besides the official Medicare.gov site, there seems to be no end of web sites offering to help you choose a plan, the problem being that most of them were developed for the sole purpose of steering people to choosing their plan, and that's not so much what I'm interested in. I'm mostly interested in your own experiences, good or bad, and your own thoughts on one plan versus another, etc. Costs versus benefits, that sort of thing.
I used to bill insurance claims for a outpatient health center. Many of the patients had United Healthcare's medicare plan as a supplement to Medicare. I myself would like this as a secondary to Medicare. I saw that the patients' responsibilities for the most part was the co-pay. Unfortunately the premiums were unknown to me and would be the primary decision maker. Most of the other supplemental insurances had deductibles and a 50/50 ratio on every treatment with limited number of visits, in-network only; or higher out-of-pocket if not in-network. The health center had UHC when I first started working and I loved it I had Anthem for one year when there was the contract with UHC wasn't renewed. I hated it.
We have medicare and a medicare supplement from Humana, plan F. Medicare pays 80% of the amount they approve and plan F pays 80% of the rest. We also have a separate drug plan. We can go to any doctor or hospital, even specialists. Medicare Advantage plans are what used to be called HMOs. You have to pick a doctor from their list and go to a certain hospital. You also have to get pre-approval for many procedures. They seem to be much cheaper but I wouldn't want one.
Well I went with the HMO because my dr and favorite hospital were on it. Also it's free and I don't have deductibles And hardly any co pays or very low ones. Today is my first day on medicare and I have A and B. I figure that for this year this plan is ok. Between medicare and the HMO if I have to pay something out of pocket and it's small I can manage that. If it's a huge amount, they'll have to eat it or work out a payment plan with me. I have nothing they can take. If I wasn't on this HMO, I would pick my dr and the same hospital so that's what made me decide on this.
First, Medicare A is Hospitalization and free........no monthly premiums. Wife and I have Medicare B (Medical), Florida Blue (Supplement) and Humana Wal Mart Rx (Drug). I pay $104.90 premium a month, but my wife pays $121.80 premium per month due to her income where she works. The only income I have is my SS. We both pay our Medicare premium each month automatically taken out of our SS payment. If a person, like my BIL, isn't getting SS, then Medicare requires the person to pay a 3-month premium thru personal check or banking acct. Anyway, our Florida Blue pays for the total amount that Medicare charges upfront for being admitted into a hospital. Our Florida Blue Supplement premium per month is $159.60 for each of us. Our Humana premium per month is now $17. Both our supplement and Rx went up at the beginning of 2016. I had a rotator cuff surgery last year in March that cost around $38,000. This included the surgery, PT, Rx (pain med) and three post-op follow-ups by the surgeon. We paid (out-of-pocket), something like $500. This entire medical thing for me is much better than the VA gives me. Getting ready to leave the VA Medical, but will still have my medical benefit with them if I ever need it.
Why am I paying $121 a month for part B? Wow, a supplemental is expensive if it's not an HMO, although I was worried about the HMO I chose it because of the no deductibles and no copays. And like I said, what can they do if I can't pay a $200,000 bill? Can they garnish my widows benefits? Take my car?
We have a Medicare Advantage plan and it works great for us. I still have the same doctors as I had before, and same hospital, same level of care, too. I have heard bad things about getting an Advantage plan, but I am well pleased with mine. We have an independant insurance agent, and he can sell any kind of Medicare supplement, so he went through the available plans that met our needs and we have Cigna Healthsprings now. One of the things that both Bobby and I love about our advantage plan is that it includes a fitness membership. If you don't live close to a fitness center, or have no interest in going to one, then this would not matter; however, if you do have an interest in exercising and taking beter care of hour physical health, hen it is a blessing and a big savings. We love going to the fitness center. I was actually thinking of including that in the hobbies thread, because it is something we both enjoy doing , and we try to go there every other day. Cigna also has a little booklet that they send you and you get something like $25 each month that you can spend on ordering OTC meds or even vitamins and medical devices. Our insurance agent said that they are not allowed to mention Advantage plans unless the person specifically asks about them, and otherwise they will just tell you about medicare supplements. I don't know if that is everywhere , or just in Alabama; but if you are interested in checking out Advantage plans, ask about them just in case.
I get $50 a month for OTC with my plan, Yvonne. How much is your medicare plan B, Yvonne if you have it? The guy from the HMO was surprised mine was $121, he said they are usually $105. Now I see Cody is only paying $105, maybe I should call them.
It must be different everywhere then, Bonnie. My HMO guy is from here though and he was sure it was $105. I signed up on time. Does anybody know what happens if you can't pay a huge medical bill? What can they take? After my husband died I got the bill from the hospital in San Francisco and it was $600,000! Thankfully our insurance then covered every penny.
I will have to look and see how much we get for the OTC plan, @Chrissy Page . I always forget to use it, and now I really don't remember how much they allow. I would think that most of the plans would be competitive; so if you get $50, we may get that much as well. Since I didn't work much, was a stay-at-home-mom most of my working years, I only get a little over $400 a month for SS. I used to get SSI before Obamacare, and then I actually got over $500 a month, which was awesome. Anyway, since I am so low-income, I qualify for Medicaid, and they don't charge for the part B Medicare. Bobby gets a little more than I do; but he is also below poverty level; so we both have Medicaid coverage. He was in the military and served in Viet Nam; so he also has the VA, which has helped him with medical issues before he got medicare.
Okay, I didn't qualify. I would have if I was relying on my SS income which would be very low but I have part of my husbands SS which was pretty good. I'm usually over the limit for most things and that's why obamacare wasn't helpful to me at all. I didn't qualify for free ins. But did for help with the premium but those plans weren't the blue cross plans that are good they were more like an HMO and my dr didn't take it nor could I even find one close. I wasn't going to go see a dr in the bad part of town so I never got obamacare and just managed paying cash for lab work etc. My first day of medicare and all I am is worried. I've waited so long for this day but not even sure how it will all play out. I do know I will have to have a wellness check and that has me very anxious, I don't like tests and can't even see myself going for one all by myself.
I just read on the Medicare.gov website that most people pay $105 per month premium, but that's not everyone, including my wife. Medicare goes by IRS reports/yearly income. They distinctly say that some people will pay $121 a month. Actually, wife and I are very happy to have Medicare A & B, Florida Blue Supplement and Humana Wal Mart Rx Plan. I know my medical should be a whole lot better than the VA Medical I've been using for Labs, Labs Consultation and the prescriptions I get from them. There is no VA Hospital close to us and, from what I'm told, no medical services will accept my VA Member Card. You show your Medicare Card, Supplement Card and Rx Member Card and you are "in like Flint"....totally accepted!
I did not want to be tied to one set of dr's so I avoided HMO's. I have Medicare a and B, and supplemental with Mutual of Omaha. It's pricey but it has paid every dime of both me and my wife's medical bills. I have had that insurance since for almost 15 years. I have used it in 5 states.