I recently joined Medicare as I've been on social security disability for 24 months. I have prescription coverage through Express Scripts @ 82.00 month and need to choose either a Medicare supplement by Premera @ 357.00 month or Medicare advantage also by Premera @ 0.00. Medicare costs 124.00 a month. In the past I've discovered that the most expensive option is the best. In this case I'm not sure.
Any opinions?
Becky Jackson
TZ Insurance Solutions LLC Licensed agent
Appointed by Mutual of Omaha Insurance Companies
1-800-966-5954 x7638
becky.jackson@tzinsurance.com
I was already diagnosed when I was retiring and had to choose. I chose the Medicare supplement and boy am I glad. My PT and OT sessions for the BIG program were free, my copay to see any specialist or have any lab test is $10 , there is no need for a referral, and there is the peace of mind the if I have to be hospitalized I won't see big bills. Also you may not be able to get this insurance if you are on a Medicare Advantage plan, incur large bills and try to switch.
Yes the premiums are pretty high but since I have some anxiety around unexpected financial problems, absolutely worth it. That said, many Medicare Advantage plans have low or no premiums and the care is good, but high copay for everything. It's a shame that here in the US we have to do risk management with our health care.
From what I can tell, all of the Medicare Advantage programs are some kind of HMO where you have a primary care physician who acts kind of like a "gatekeeper" for any other doctors (specialists, etc) that you want to see in addition to him/her. The Medicare supplement programs can be PPOs or there are some other letters too, and I can't think of what they are right now. (I have a PPO type supplement with Anthem Blue Cross myself.) All of my experiences with HMOs over my lifetime (two or three?) so far have been ones I don't want to repeat. I want to be able to see who I want to, and I don't want to be having to convince one doc (the PCP) about my reasons for wanting to see a specialist, for example. I hope to never go back to that type of health plan again. (We also had a very bad experience with trying to get an unbiased 2nd opinion when we had the Kaiser HMO, and ALL of the docs at all of the facilities were interconnected, and no one would contradict the original doc's diagnosis (which was eventually proven to be wrong when we finally went outside of Kaiser. Nightmarish experience.) So when I see the word "Advantage" and I understand it's "code" for "HMO," I run! Others DO love the HMOs, and that's great. The costs are probably a little more controlled than with the PPOs, etc. Medicare covers a lot already, so the supplement just kicks in for the portion Medicare doesn't cover. It's been a real positive experience for us.
If you enroll in a Medicare advantage plan and stay there for one year, you can never leave that type of plan. It is basically a HMO where Medicare pays the company a certain fee each month for each member. The company then pays all claims from those fees. The company claims board determines what medical treatment the will pay for. Many times the allowed procedures are age determined. (You can read into that statement what ever you want to.) You must use their panel of providers and need referrals for most. If you can afford it a supplement plan pays more and does not require a certain panel of providers nor does it require referrals.
Medicare Advantage plans vary from State to State. In Western NY, our plans are very good. You can change every year and if you are 65 or older, you can get EPIC which allows you to change plans once during the year if your needs change. My Primary visits are $15 and specialists are $50. My premium is only $65 a month.
Medicare Supplement plans don't include prescription drug coverage. If you want drug coverage, visit Medicare.gov to learn more about enrolling in a Medicare Prescription Drug Plan (Part D). Supplements are designed to help cover hospital and doctor costs not paid by A and B.
Medicare Advantage (Part C) plans also include Medicare Part D prescription coverage. If you opt for C you don't get A, B, or D. As previous posters have cautioned, you probably have more limited choices of doctors, meds, and facilities if you choose C.
My son also was approved for SSDI and is enrolled in Medicare effective 5/1/17. Medicare supplement plans seem more expensive for people under 65!
One more thought is that coverage you choose now is only good through Dec. 31st. (Someone please correct me if I'm wrong .) You have a chance to choose something different during open enrollment this fall if you are not happy with the status quo.
you are correct
Excellent info thank you so much! Even though we may be thousands of miles apart geographically the support and encouragement and unique perspective of our shared diagnoses is a huge blessing!
Cautionary tale for those on Medicare
Medicare coverage for massage or acupuncture in PD?
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MONEY
Neupro
