A good Sunday morning to you my friends. Since my original diagnosis 5+ years back I’ve been blessed to be on my wife’s incredible insurance plan. She will be retiring at the end of March. That said I now get to embark upon selecting the Medicare journey best suited for folks like us.
As I begin the process of due diligence I was hoping to hear from any of my Buckeye peers with any suggestions and referrals of plans you have found to be most beneficial.
thank you in advance for your kind consideration!
Written by
3putt
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I am in AZ but Medicare is a nationwide program. I went to a broker that actually called my treatment center to find what paid best for my treatments, I ended up with an advantage plan from AARP through United Health Care. I love the plan after the first year. Most meds are free and my Abiraterone is $95 a month after deductible is met
in addition to Medicare I have a high end Blue Cross Blue Shield Supplemental Plan F (no longer offered), NOT AN ADVANTAGE PLAN, which would have severely limited my choices of doctors because they require you use in network only. I live in Florida but use MOs and ROs in both Houston and Wisconsin. My PCa treatments haven’t cost me a dime. I also purchase a Medicare Rx supplement plan from BCBS as well.
The first thing you need to decide is if you want Original Medicare or a Medicare Advantage plan. Search Google and you will find lots of information comparing the 2 options. The biggest difference is Original Medicare can be used with any provider that accepts Medicare. Medicare Advantage plans usually require you to use a network of providers or else pay a lot more and often require advance approval for drugs and procedures. If you get Original Medicare you should also get a Medicare supplemwnt/Medigap plan and a drug plan called Part D.
I never said that an insurance company's network is limited to a physical location. I said that you usually must use the network approved by the insurance company. That network may indeed, have providers in multiple states. But PPO stands for Preferred Provider Organization so I assume that you still must use providers in your insurance company's network or else pay more for using out of network providers.
Your broker enrolled you for free because he/she was paid a healthy commission by the insurance company. On average Medicare pays $1000 a month to insurance companies for each Medicare Advantage subscriber.
Whether you have traditional Medicare or an Advantage plan you still must pay the monthly Medicare premium. Some Advantage plans do not charge additional premiums (they receive their premiums from Medicare). Advantage Plans are not free.
I had it great for a while.also. I had medicare part A and B and I was on my wife's commercial plan for about 5 years. I paid out practically nothing during that period. Then we figured out it's cheaper in the long run for me to be on Medicare only and she be the only one on her work plan. I decided to go with a supplement plan over an advantage plan and because of my age, I was able to get the high deductible F supplement through United American insurance. I chose the supplement because I can choose my doctors and keep the ones I've been seeing. And, I can travel the US and take the supplement with me. My high deductible is right around $2400. With regular doctors visits and labs throughout the year, I'll never meet that deductible. But, if I have surgery or my autoimmune disease becomes active again, there could be some hefty bills and I'll only have to shell out $2400. The supplement costs me $76 a month. I also have a Wellcare drug plan (part D) that costs me $12 every 3 months and I'm using a Walmart pharmacy.
We just went on Medicare in April, and I investigated all of our options quite thoroughly. I chose Traditional Medicare with. a Plan G Supplement. After our premiums, our only OOP is the $226 Part B deductible. We both have cancer, so being able to go to top notch cancer centers was important to us. No copays, no prior auth for most things, and coverage across the country without a network. In most states, if you choose an Advantage Plan, you can switch to a Supplement one time in the first 12 months, after that, one would need to pass medical underwriting. Obviously with cancer, we would never pass, so it was important to make the right decision from the beginning. So many of my friends were misled by unscrupulous brokers who did not explain that they would not be able to change to a Supplement at any time. (But you can always downgrade to an Advantage Plan.)
My company offers an Advantage Plan for retirees. I made sure I worked enough years to have the maximum in my retiree medical savings account, yet made the decision to give that up for the superior coverage provided by Traditional Medicare with a Supplement.
Many people do not realize that you are leaving Medicare when you choose an Advantage Plan, and the private insurance company is now making your health decisions. As a nurse, I have seen the downside of the Advantage Plans.
I should add that all Plan G Supplements have the exact same coverage. Pricing varies by age, sex, and zip code. I checked with 2 nationwide brokers and they both suggested the same plan at the same price, so I went with the broker that offered more customer service to their existing customers.
very well said Leebeth. Traditional medicare plus plan G supplement is best option as long as you can afford to pay the monthly suppliment premium.
If not, then consider private ins advantage plan options but realize that your future choices of drs and locations might be restricted. And that you can not switch back to medicare after first year.
Another option is to select the high deductible Plan G. The deductible for 2023 is around $2750. The deductible is about what you would pay extra in premiums if you selected the regular Plan G. I have had the high deductible Plan F for 8 years and have only exceeded the deductible in 1 year - that was the year I had an RP and 32 sessions of radiation. The other 7 years I was way under the deductible so have spent much less than if I had selected the regular Plan F.
Thak you. That is interesting...... switching to a traditional supplement from Advantage is limited due to pre-existing conditions exclusions.......but switching from a traditional supplement to an Advantage plan is never limited by pre-existing conditions exclusions???
Also, do pre-existing conditions enter the picture when trying to switch from one company's traditional plan to another company's traditional supplement? And additional restrictions if switching from a lower deductible supplement plan to a higher deductible plan?
Do you advise any one particular Medicare broker for the quality of the advice it offered?
when considering your medicare plan supplement provider, ask the broker to provide a 5-year projection of various monthly rates. It is interesting to see the companies that set year 1 rate at a lower cost that will draw in buyers. Consider the 5 year average rate when deciding.
Thank you for asking this question. My husband and I are 53 and 54 so not at Medicare yet (unfortunately for insurance)- but my parents moved in 4 years ago and I've had a lot of discussions. And just this week, my sister-in-law's husband (he's 75) was told he needs scans due to many many suspicious spots in his lungs (smoker). He made the appt but his insurance wasn't approving or denying. I said that was odd- until she said he had just enrolled in an Advantage plan with Humana for 2023. The office he was to have the scans at said Advantage plans are a 'scam' and often deny things or drag their feet. All this discussion will help me help my sister-in-law and her husband- hoping they can change using the 'once in first 12 months' timeline mentioned above! Thank you all for answering and to you 3putt for asking!
I'm in IL and after research I chose Blue Cross/Blue Shield for our Medicare supplement. We're both in our 70s and the cost is now $1,500.00 each for 6 mos. coverage. That may or may not seem high to you but for me the most important part is that we've never had to pay anything out of pocket beyond that initial cost....no copays, no hospital/doctor bills. When I see the EOBs come back with cost of tests, scans, visits, I always see the value. Besides when you tell an office you have BCBS you always get an appointment! We also have Humana for drug coverage and they cover $6,000.00/mo. for Xtandi while Astellas picks up the rest leaving us again with nothing out of pocket. Humana's cost is about $345/year. As for Medicare, we have Plan F but it was discontinued for new subscribers. Pick the best one and look at initial cost and percentage paid for services you'll need.
I also live in Ohio and I get my Medicare supplemental insurance through MediGold headquartered in Columbus, Ohio. I've been pretty happy with them so far.
I like what Leebeth said. My traditional plan is through AARP United Healthcare. My broker surveyed everything and compared zytiga costs through multiple drug plans. Find a good broker.
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