My husband retired in November of last year. He was offered and took his employer’s standard retirement benefits, which include health insurance. We currently have Medicare Parts A and B as the primary insurance and Carefirst BC/BS as the secondary and for medications. The service and coverage have been excellent for my husband’s stage 4 PC and everything else. However, my husband’s former employer has decided to change to Anthem Advantage PPO for 2023 (and presumably thereafter) - no premiums, no deductible, no copays (even out-of-network). Does anyone have experience with Anthem Advantage PPO, good or bad?
I’ve spent ungodly amounts of time trying to research Medicare, Medicare Advantage plans, and Medigap supplemental plans. It is all so confusing. My primary concern in transitioning to a Medicare Advantage plan is the potential for denial of care, especially for cutting edge PC treatments, and possible requirement for pre-approval for services. Of course, Medicare Parts A and B with a Medigap supplemental plan (probably plan F) would cost much more (hundreds) per month, but it would be worth it to us if it ensures better coverage with less hassle in the long run. Any thoughts or advice?
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When picking insurance provider for Medicare I went to a local Insurance broker that specialized in Medicare plans. He actually called the center where I get treatment and compared plans with their insurance people. Very happy with my plan
Scruffy, I wrote a reply but it didn’t seem to post. Anyway, thank you for your input. We’ll be going to the local Office on Aging to get their unbiased advice re Medicare options.
I recently went through some radiation treatments, and I became friends with other men in a similar situation. One person complained about how hard it was to get his radiation approved with his advantage plan. I had no issues with Original Medicare and a supplement policy… but I have no idea if I was lucky, or if the other man was unlucky. However, I have no complaints with original Medicare.
I believe you have some rights when your plan terminates:
There could be pharmacy benefits (drug coverage) to the advantage plan your being offered, that wouldn’t be available under original Medicare with a Part D policy; and that is something you would need to triple-check to be sure. Finding a caring and competent agent is highly recommended as you sort through your options. I currently use AARP policies, and (knock on wood), they have worked well for me.
I am not an agent and know very little about available options but it is without a doubt, stressful to sort through all of these issues. I very much wish you the best.
Thanks for your response. We need to check further re pre-approval under the Anthem advantage plan. My husband’s current medications are covered under the Anthem plan (with a $100/month copay for abiraterone). As noted above, we plan to talk to the local Office on Aging for advice re our options. It really shouldn’t be this hard.
Presumably yes, under a Medicare Medigap supplemental plan (probably type F, which is very comprehensive - and expensive). But that would mean terminating group coverage under my husband’s former employer, which we are reluctant to do, in part because it’s essentially free for the rest of our lives. It largely comes down to a question of trust. Can we trust Anthem not to screw us over and deny care or require pre approval for every scan and procedure? We just don’t know. Hence the request for input from the community, many of whom have presumably been there and done that.
Having a supplement plan and PC, there is no way I would switch to an Advantage plan. I was allowed to do the opposite when I got my DX as it was within 6 months of my original medicare enrollment. The big cancer centers like Mayo, MD Anderson etc. do not take medicare advantage plans btw.
Thanks. I believe the Government allows you to switch within the first 12 months without penalty or underwriting. Anthem Advantage claims that they are a preferred provider with John’s Hopkins in Baltimore, the closest major cancer center to us.
There was a rather long discussion here within the past week of Advantage vs standard Medicare + Plan G (and Plan D) - the general feeling was if you can get standard Medicare you'll be a happier camper. An article I read had some links to documents about the money insurance agents get when they sign someone up for an Advantage plan - it was over $600 PER YEAR (and it just keeps coming as long as the person remains with the plan.) That alone should tell you what you need to know - the Advantage plans are quite profitable for the insurer, and they'll do what's needed to keep them profitable. That's also why the endless ads for "GET what you DESERVE" starring all the old broken-down actors and sports figures.
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