Medicare Advantage (some ins. co call it Plan C) U.S.

[cllady01]

Here is the clearest information on MA I have seen recently--or maybe my head is a bit clearer today. You can use the list beside the article to choose any part you need a refresher on.

medicareinteractive.org/get...

[dvd1955]

Thank you! I am turning 65 in January, and it is a struggle trying to determine what is the best option. My biggest concern is the cost of prescription drugs. I was on Imbruvica, until I had an adverse reaction. With my current insurance, I had an extremely low copay, considering the charged cost of this medication. Any of the plans I've looked at so far will cost me thousands more per year if whatever my new treatment will be has a similar price tag as Imbruvica.

Dave

[cllady01 Former Volunteer in reply to dvd1955]

dvd1955, In the following links, there are links suggested by members for getting financial help. I have not tried any of these, and have not yet been treated, but I share as many do, the need for assistance if the costs are as have been presented.

healthunlocked.com/cllsuppo...

medicare

healthunlocked.com/cllsuppo...

assistance

healthunlocked.com/cllsuppo...

[Grieb]

Medicare Advantage Plans that require use of "In-Service" doctors and hospitals are designated HMO plans. PPO (Preferred Provider) Advantage plans do not "require" use of "In-Service" doctors or facilities but generally have a slightly higher copay for "Out-Of-Service" providers.

PPO Advantage Plans generally have monthly premiums that are much lower than the combined, monthly cost of Medicare + Medigap + a Part D drug plan. The difference in monthly premiums generally amounts to the maximum, annual out-of-pocket limit within 2 or 3 years. Advantage Plans are required, by law, to accept patients with preconditions and provide specified minimum coverage but they are allowed, by law, to offer additional benefits (dental, optical, free exercise club membership, prepaid cards for purchasing meals at specified restaurants or other merchandise-- following completion of preventative care tests, etc.) to obtain a marketing advantage.

Available Advantage Plans (just like the Medigap Plans) vary from area to area so the client must check for local availability. Selecting the Medicare plan that results in the lowest overall cost, to the client, over the course of a year or more requires guessing how many times the client will be hospitalized over that time period. However, the maximum cost for guessing incorrectly is limited by the maximum out-of-pocket limit in the Plan.

Bottom Line--my wife and I have an Advantage Plan and, even tough she takes a lot of medications and, periodically, requires expensive hospitalization, our overall costs are less than they would be if we had original medicare plus a Medigap plan plus a Part D Plan.