Medicare

[eldirector]

Didn't know a good forum for this, so....

I'm PoA for my mother, and handle her finances and medical "stuff". She signed herself up for a Medicare Advantage plan several years ago, before she asked that I start helping her. It has been fine, to a point, but her needs have certainly changed. I THINK she would be better on straight Medicare with supplemental insurance. However, I really don't know one bit about Medicare, and there are thousands of options for supplemental. Are there some kind of services that would walk us through the options? All I have found are via actual insurance brokers, who only talk about what they sell.

 

[Sailor]

How is her health she will have to qualify now. Who is her advantage plan through? Is she having problems with her doctor not being in the PPO?

If you go straight medicare/medicare supp she will have to pay, $170 mo for medicare, the cost for med supp, drug plan, vision and dental.

 

[Snapdragon]

Didn't know a good forum for this, so....

I'm PoA for my mother, and handle her finances and medical "stuff". She signed herself up for a Medicare Advantage plan several years ago, before she asked that I start helping her. It has been fine, to a point, but her needs have certainly changed. I THINK she would be better on straight Medicare with supplemental insurance. However, I really don't know one bit about Medicare, and there are thousands of options for supplemental. Are there some kind of services that would walk us through the options? All I have found are via actual insurance brokers, who only talk about what they sell.

Medicare.gov has a page where you can look at all the options. You can even input all of her medications and see the cost with the different insurances. (Of course if she went to supplemental, she would need a separate drug plan.)

Find a Medicare plan

www.medicare.gov

 

[Snapdragon]

Medicare.gov has a page where you can look at all the options. You can even input all of her medications and see the cost with the different insurances. (Of course if she went to supplemental, she would need a separate drug plan.)

Find a Medicare plan

www.medicare.gov

For what it's worth, I have had Aetna Medicare Replacement (Advantage/All-In-One plan) and I am pretty happy with it. It's about the most reasonable option for me except for a couple of bargain basement policies I have never heard of.

 

[Hardscrable]

My wife me I were on Medicare plus a supplement for several years. We were happy except cost rose each year. Now on a Medicare Advantage plan. Our CPA had an in-house insurance business. The helped up originally. That was sold to another company. We have an agent that goes over everything annually including doctors, prescriptions, etc. and recommends best plan for us. Hasn’t cost us a penny.

If you want their contact info, PM me. Might be worth the call, if not you are not out anything but a little time.

 

[BugI02]

If you go traditional medicare and get a part G supplemental and a drug plan, your Mom can see any doctor who accepts traditional medicare and her total out of pocket expenses would be limited to around $200, which is significantly less than what the max out of pocket of an 'advantage plan' would be. You would need to price her exact situation and compare what she would have to pay in expenses and for drugs as well as the $200 OOP, keeping in mind you pay that all the time whether sick or not. You might find that the breakeven point between the fixed costs of the two plans is closer than you think

That said, I can't remember precisely how it works so I may have this backwards, but I think if you go to traditional medicare you have guaranteed acceptance but not if you want to switch back. Going from traditional medicare would expose here to actuarial processes that might deny her access to a chosen plan or result in a much higher price than advertised

I know it is hard to believe, but the recommended gov't site (medicare.gov) wasn't bad when I used it a while ago. Keep in mind she has less than a month to change plans during this years open enrollment period

 

[JCSR]

I strongly suggest you seek the help of a professional. Find a trusted insurance agent that can walk you through each plan. It can be done yourself but a small mistake can be costly. If you were in the Evansville area I know of a good agent. Good luck, getting old sucks.

 

[Ziggidy]

I have medicare and supplement, for 5 years and would not change. My wife just started and we both have the same.

YES, it is more costly up front BUT like anything else it's a gamble - IMO. You need to weigh your options and situation. I can go anywhere for care, even out of state. I have no out of pocket once my yearly deductible is met ($200?) I do not have review boards that will provide authorization for care. I dot not have to worry about yearly contractual agreements within advantage programs. There is more....

I wouldn't switch.

Of course, this is just my opinion and everyone has to see what works for them.

 

[Ziggidy]

BTW - we give up allot of freedom when we go to an advantage program.

 

[dvd1955]

In Kokomo there is an organization called Samaritan Caregivers that does this very thing: help you decide what will work best for you. Not affiliated with any insurance company so unbiased. There should be organizations like this in most large towns and cities.

 

[PGRChaplain]

I changed from a Supplement to an advantage plan this morning. We use Insurance Matters, offices in Ft Wayne and Warsaw. Medicare plans is all they do. They do a side by side comparison and explain everything in depth.

 

[04FXSTS]

Retired in 2013 and went with supplement plan "B" for several years but now have been a "G" plan about 3 years. The only difference between "B" and "G" is I do pay a deductible each year, but the monthly premiums are less each month. At the end of the year I end up paying less on the "G" plan with the same benefits. There is now a "N" plan that works differently, you pay a deductable and co-pays but the premiums are even lower so you would end up paying less at the end of the year as long as you don't have to see a doctor too much. At least that is how it looks at first glance, read the fine print. With this one if MEDICARE DOES NOT PAY SOME CHARGES YOU ARE RESPONSIBLE. I would avoid that like the plague, the company I talked to about the "N" would also charge you 15% surcharge. Jim.

 

[doddg]

Medicare can be quite a confusing web.
There isn't a simple one-plan-fits-all, unfortunately.

When the wife turned 65, 2 yrs. before myself, I paid a $300 fee to a company called
Medicare Simplified.
They tutored us about all the options available so we could choose best fit.

These same services are offered free by some programs, but I couldn't afford a mistake since once we choose a path, we could never switch b/c of the ongoing medial conditions that would deny us to be able to switch after we chose.
We had to get the choice right first time around.

I just had a 72 yr. old friend switch from an Advantage plan to regular Medicare & a supplement since it was better coverage for him.
His wife, who was of bad health, was turning 65 & he had learned that the Advantage plan would have some serious out-of-pocket expenses for her, that he had not yet experienced.
He will pay an additional $100 per month, plus a drug plan, but feels it would save him money in the long run.

Our circumstances were of ongoing high medical usage b/c of heart, diabetes, cancer & other medical issues, some lifelong.

The Advantage Plans are attractive with their low price & can fine for those of decent health, but our medical services needed are quite high so we went with a supplement, Plan G to limit the ancillary costs.

 

[doddg]

Retired in 2013 and went with supplement plan "B" for several years but now have been a "G" plan about 3 years. The only difference between "B" and "G" is I do pay a deductible each year, but the monthly premiums are less each month. At the end of the year I end up paying less on the "G" plan with the same benefits. There is now a "N" plan that works differently, you pay a deductable and co-pays but the premiums are even lower so you would end up paying less at the end of the year as long as you don't have to see a doctor too much. At least that is how it looks at first glance, read the fine print. With this one if MEDICARE DOES NOT PAY SOME CHARGES YOU ARE RESPONSIBLE. I would avoid that like the plague, the company I talked to about the "N" would also charge you 15% surcharge. Jim.

That is what we discovered.
Our Dr. visits are 1-2 times per week between us with rarely 0 in any given week, so we do better with not having to copay each Dr. visit.
We did the math, haha!

 

[Ziggidy]

Medicare can be quite a confusing web.
There isn't a simple one-plan-fits-all, unfortunately.

When the wife turned 65, 2 yrs. before myself, I paid a $300 fee to a company called
Medicare Simplified.
They tutored us about all the options available so we could choose best fit.

These same services are offered free by some programs, but I couldn't afford a mistake since once we choose a path, we could never switch b/c of the ongoing medial conditions that would deny us to be able to switch after we chose.
We had to get the choice right first time around.

I just had a 72 yr. old friend switch from an Advantage plan to regular Medicare & a supplement since it was better coverage for him.
His wife, who was of bad health, was turning 65 & he had learned that the Advantage plan would have some serious out-of-pocket expenses for her, that he had not yet experienced.
He will pay an additional $100 per month, plus a drug plan, but feels it would save him money in the long run.

Our circumstances were of ongoing high medical usage b/c of heart, diabetes, cancer & other medical issues, some lifelong.

The Advantage Plans are attractive with their low price & can fine for those of decent health, but our medical services needed are quite high so we went with a supplement, Plan G to limit the ancillary costs.

IMHO, Medicare with Part G Supplement is the best out there.

I do disagree about medicare plans being confusing, they're not. It's the darn advatage plans that are hard to understand and don't you fully know till it's too late. NOt that way with Medicate and a supplement. Watch for them MAX OUT OF POCKET Schemes with advantage. It's a no brainer when you're young, but at out age, anything can happen and you best be able to afford it with the advantage plan. Go out of network with advantage? BAMM Want to see a different dr for another opinion - BAMM. YOU best be pre-authorized first! But not with Straight Medicare with supplement.

 

[BigRed]

I've seen several commercials on this.

Coach Frank Reich told me IU is the mostest bestest.

I listen to folks that coach guys playing a ball game on how best to get the most from plundering my neighbors. After all, they know!

 

[wabash]

for those making their choice, look at high-deductible supplements, too.

I changed from a Supplement to an advantage plan this morning.

why?

 

[tsm]

I changed from a Supplement to an advantage plan this morning.

Just remember that if you’re not in the best of health in the future and ever want to change back, Supplement plans will be able to review your health and charge you more or even refuse to take you depending on what they find.

 

[Snapdragon]

IMHO, Medicare with Part G Supplement is the best out there.

I do disagree about medicare plans being confusing, they're not. It's the darn advatage plans that are hard to understand and don't you fully know till it's too late. NOt that way with Medicate and a supplement. Watch for them MAX OUT OF POCKET Schemes with advantage. It's a no brainer when you're young, but at out age, anything can happen and you best be able to afford it with the advantage plan. Go out of network with advantage? BAMM Want to see a different dr for another opinion - BAMM. YOU best be pre-authorized first! But not with Straight Medicare with supplement.

I disagree about advantage plans being confusing. Every policy has an Evidence of Coverage document, which should clearly spell out the coverage and cost for each service, including in network/out of network costs. You should be able to request one from any potential insurer, as well as a provider list to see who is in network. I keep mine bookmarked on my PC.

 

[Tanfodude]

My advice is to never, ever use a medicare substitute as her primary, as if ever she needs sub-acute rehab, she will get cut regardless if she's not functionally safe to be by herself. Always use medicare as primary and insurance as supplement.