Jane, I learned so much from you. If you're still reading, I need your advice. I think I may need to change our Medicare supplement. I read in one of your posts that we should stay with original medicare. We didn't but can we go back to original Medicare and pick up a different supplement?
I'm not Jane but I'll try to help. You can go back to regular Medicare during open enrollment. It will be well advertised-I think it will be in January. For my supplement I have AARP. It is an automatic crossover to Medicare which means the offices have no problem filing for you. I have no deductible and have not had to pay a penny out of pocket. Best of all-they are easy to reach by phone and you get an English speaking, patient person. Doctors' offices will fit you in sooner because they know their reimbursement will be coming. Jane-come back
Thank you, bluedaze. Our insurance is somehow a combination of Medicare and supplemental insurance. We don't have medicare now. They told us to just tuck the medicare card in the back of our wallet and only use their insurance card. I understood from Jane that this is not a good thing because they can determine your treatment.
Is AARP set up this way or do you have regular medicare and the AARP is a different supplemental insurance? Our prescriptions are covered by my DH's former employer. We pay $88.00 per month for both of us plus part B premiums for this other insurance. We have a $10.00 co-pay for doctor visits. How does this compare with AARP?
I hope Jane is still reading and will come back. She is really up on all this stuff and was so willing to help us.
Dazed, what you have is an Advantage plan. They come in two types. A PPO and an HMO. HMOs are managed care, but PPOs aren't. Which one do you have?
I've got an Advantage plan that is a PPO. I have never been told that I can't go to any doctor I want to go to. In my area all of the best specialists accept my Advantage plan. My current therapist is not on the plan as yet, but they are working on it. That means I do have to pay an additional payment to go to her, but it isn't all that much extra.
My husband has Medicare and a Medicare supplement from a different company. We pay twice as much for his insurance as we do for mine. I have a co-pay, like you do. He does not. The real question is do your doctors accept your insurance? We have gone to the same medical groups, both family doctors and specialists. They have accepted both policies and both companies.
In a serious illness there won't be any real difference between the two policies we have in my house. The differences are in the up front costs.
Jane=where are you. Dazed-AARP is the gap between Medicare Part A and B coverage. It covers the deductable and 20% that would come out of your pocked. Part D is the prescription plan. Here is the AARP Health OPtions # 1-800-523-5800. They should be able to answer your questions. Keep in mind that AARP is just one of many approved plans.
AARP medigap is a supplement to regular Medicare, not a combo with it. Medicare pays first, then the remainder of bills to doctors, hospitals, etc, is paid by AARP. We do not have a co-pay with that, though every now and then the doctor will order a test that Medicare won't pay for and we have to pay something. We also have Medicare Part D, the new kind that pays for prescriptions, through AARP. Altogether we pay $338/month to AARP, and of course medicare comes out of our social security checks. I have a slightly higher category than my husband because it covers out of the country care (as for when I travelled, way back when, a year ago) So yours is considerably cheaper than ours - how much is the part B?
One of the problems with giving information about government programs is that the laws change frequently, and it is difficult to keep the information up to date. Jane's information has always been excellent, but she has warned that the danger of reading old posts is that the information could be incorrect due to law changes, either in the Federal or State laws.
Daze, I have not been reading the forums until today. One of the members that I have been corresponding with had mentioned the forum and I thought I would read through it. Some of you are like family to me. I do care what happens to you. Daze, be very careful if you start to change regarding the Supplemental policy. True you can opt to go back to regular Medicare but when you are talking about the supplemental Medigap you can run in to problems with getting one. First, if you are in an employer plan as it seems you may be, then dropping the Advantage plan can cause the employer plan to drop you. Second, there are only certain situations that will allow you to get the Medigap, supplemental plan without triggering a 6 months waiting period for any pre-existing condition.(1) Your Medicare Advantage coverage ends because the plan is leaving the Medicare program or stops giving care where you live, (2) Your employer group health plan coverage ends, (3) you have to end your health coverage because you move out of the plan's srvice are.(4) You joined the Advantage plan when you were first eligible for Medicare at age 65 and withing the first year of joining you want to leave the plan. (5) You dropped a previous Medigap policy to join a Medicare Advantage Plan for the first time and now you want to change and you have been in the plan less than a year. (6) your Medigap insurance company goes out of business and you loose the plan through no fault of your own. (7) you leave the Advantage plan because the plan has not followed the rules and has misled you.
bluedaz is correct that you can leave the Advantage plan to go to regular Medicare, but you are asking about the supplemental and you have to be careful there.
I hope I have helped and not confused. When you read a post that I gave someone telling them they could leave and get a Medigap, If I remember correctly that person was still employed and thinking they needed to change before leaving employment, they would have the option at the time they leave. When you have already left employment the answer changes, that is why you cannot read a post given to one person and think it applies across the board, it does not, the situation can make the answer completely different.
Jane, thank you so much for coming back to help us and yes, we are like family here and I know you care what happens to us. You show you care by helping us understand about some of these things. Don't leave us again. We love you and we need you.
About my insurance, we have company paid supplemental hospital insurance and we pay extra ($80.00 a month for both of us) for the prescription plan provided by the company. They do not pay anything on doctor's visits or outpatient care. We chose not to do the original medicare but chose an Advantage plan instead which is only $88.00 per month for the two of us as long as we pay the Part B medicare premiums. Part B premiums are paid by his company so I don't even know how much they are.
We do have to use doctors and hospitals who are in the network but all of ours are. Actually we've been satisfied with what we have but have just learned that the company (not my husband's work company) combined with medicare is selling to Humana and we don't know what kind of care we'll be getting. That's why I wanted to know about alternatives and I remembered from a former post you said it was better to stick with original medicare.
Does anyone have Humana. Jane, do you know anything about them?
Dazed, let me be sure I understand you. Is the Advantage plan paid in anyway by your husbands company? It seems if I am understanding and reading this correctly that they required you to use an Advantage plan as part of the benefit package? Am I correct? If the Part B premiums are being paid by the Company then that would seem to be what has happened. Please let me know before we proceed to talk more about it so that I can be more helpful to you.
Jane, when my DH retired, the company plan was so expensive, we decided not to keep it but go with an Advantage plan connected to Medicare. However, the company still had a free plan for retirees which was paid by the company for hospital and prescriptions only. However it doesn't pay anything on doctor's visits or out patient surgery so we needed something else besides Medicare. With this was also an agreement that the company would pay for (or really they just reimburse us on his retirement check) Part B of Medicare. At the last contract this coverage was no longer free for retirees. We pay $80.00 a month for both of us to keep this benefit. Of course our prescriptions are way more than that so it's still a bargain. We have a co-pay for prescriptions but it is small.
What concerns me is the Advantage plan which is not part of our company benefit, just a part of Medicare. It is being sold and we don't know what to expect. I really need more information about what's out there and the best way to go.
Jane, I appreciate so much your willingness to share your knowledge about this and so many other things.
Ok Dazed, I understand your situation now. First let me say to you, check with your company retirement plan before you make any changes and make sure even though you only have Drug Coverage, they are in some ways paying your Doctor visit part also because they are also giving a benefit to you for the Part B plan, even though it is not free, it is less than you would be paying if paying on your own. The way I am reading this it seems that Part of the Benefit with the Company is the Medicare Part B, (Maybe and maybe not,) Just to be sure you need to first check with them and make sure that if you drop the Advantage plan now to be called Humana that it would not in any way stop any of the benefits you are now receiving from the Company.
Humana is just another Advantage Plan so to speak, there are many plans offered under Humana and it would depend on which plan the contract is under. It is hard for you to know which way to go with no more information than you now have.
The problem you face is when trying to obtain another Medicare Supplement not under Advantage or Humana and the waiting period you will face before being covered for any previous diagnosed illness. It can be tricky.
You say you have been happy with the Advantage plan you have now, and true there is nothing wrong with them with the exception that you have to go to the in network Doctors and Hospitals, and if I am not mistaken they do not cover the out of pocket part if a NH is used for skilled or rehab care like the regular supplements do.
My problem with the plans other than regular Medicare is just that you are required to go to the in network Doctors, and Hospitals, and those Doctors and Hospitals can be in the plan one year and opt out the next year. It is the uncertanity that I don't like.
NEVER drop any plan until you have been accepted into the new plan that you choose. Remember the waiting period of 6 months, make sure you will not loose benefits from the company that you are now receiving .
Jane, you've been a LOT of help! I didn't know the Advantage plans did not cover the out of pocket expenses for NH Rehab. Isn't that 20% of the cost?
Until AD hit, we've been pretty healthy. Now, I'm concerned about care for an AD patient and it looks like no help is available for ordinary care either at home or in a NH no matter what kind of insurance we have. Long term care is the only thing and it's limited. We don't have that.
I suppose my best bet is to wait and see what happens when Humana takes over. Is there a waiting period of 6 months even if we change at the beginning of next year?
I will check with my husband's company to see if the Part B benefit will be affected if we make any changes. I hadn't thought about that. I also had not thought about the possibility of any of our doctors opting out of the network....Oh my, that's something to consider. Thanks for bringing that to my attention.
Dazed, as I said, I am not positive about the Advantage plans not paying for NH rehab but I do not belive they do. Check your policy to be sure. There are so many plans it is hard to keep up with them.
There is a pre-existing waiting period of 6 months on a regular Medigap policy if you change for any reason other than those I stated in my previous post. I am speaking of Medicare supplemental plans here Dazed. Not Medicare, just the supplemental plans, that was what you were asking about.
When you are checking with the company about the benefits being affected ask about any of the benefits, not just the part B, ask about the prescription plan, ask if you would loose any of it by dropping the Advantage or Humana.