Insurance realties

[kellyscats1]

This is for all of us in the USA who are medicare age or will be. \

I see a lot of responses here telling people to just change doctors if they are unhppy with their present doc.. unfortunately it is often ore than difficult to do

When we age into Medicare we are faced with insurance choices. We are bombarded on TV with ads promoting advantage plans as the way to go. The monthly premiums are lower up front but sadly with co insurnce and co pays it can cost far more in the end that a supplement.

The disadvantage with a supplement is the need to buy a pharmacy plan seperately, but there are many to choose from. Good RX is usually cheaper on my meds that my plan.

I worked many years as a case manager for an advantage plan and it ws almost impossible to see a specialist. Their plans save money by keeping you with your primary care doc to manage most everythig. Unfortunately they are not often skilled at many afflictions.

You are also limited by which docs tke your plan, and need pre authorization for most everythig.

Supplement plans have higher monthly premiums but one your deductible is met.. usually 200 a year everything else is covered at 100% and you are free to see any doctor that accepts medicre which is most every doctor.

The down side is with the execption of the year you reach medicre age you need to be underwritten and if you have any health issues like CKD you may be denied. So it behoves you to look into this the year you are eligible. At that time.. first appication you must be accepted and the same premium as everyone else.

Advantages plans offer HMO and PPO with different premiums, but providers still must accept plan. In large urban cities there are more choices, but with a supplement plan you can see any doc in the country as long as they accept medicare.

It is a complex system ..

I have no information on the health plans in the UK or Canada

[drmind]

Be careful with some advantage plans. If you're hospitalized amd you see specialists who are not on your advantage plan, you pay 100% of the bills. It adds up. Don't be hoodwinked by all the extras like groceries and no premiums, just make sure a serious hospitalization can be paid for by the insurance. All the extras sound great, but remember you're buying health insurance and not groceries or gym memberships.

oods and

[orangecity41 NKF Ambassador in reply to drmind]

That is true but my original Medicare Part B supplement got so costly that could not afford it. I even tried to get a lesser option but was told by insurance that I could not change to lesser options but only higher options. I was stuck for very high premium. I was able to change to Advantage Plan that would accept CKD and even have a special program for it when needed. So there are many options to consider on selecting.

[Kam73]

it was my understanding that if you start off with an advantage plan and then want to switch to “original” Medicare you can be denied or you have to pay a higher premium because of a chronic condition or cancer. Have you any insight to that?

[kellyscats1 in reply to Kam73]

That is the truth. You will need to be underwritten and can be denied. Having CKD is almost a sure denial. The only time there is sure axxeptance is when you first become the age for medicare. You have oly one chance..

I would not touch an advantage plan and I cunsel all my friends who are ready for medicafre to get a supplement plan.

[Coolbeans62 in reply to kellyscats1]

The only disadvantage to supplement plans is that the premiums go up every year. It's the best option in my opinion if you can afford it.

[Kam73]

I totally agree.

[kellyscats1]

Sadly people fall for the tv adds.....sooooo misleading

[jodaer]

I agree too. I'm on original Medicare. They pay for most anything if a doctor prescribes it. The only caveat is they don't pay a lot, but most doctors will accept their payment. You can change doctors whenever you want, do not need a referral to a specialist. I also would not touch an advantage plan for any reason. If you don't know what you need, most if not all states have a SHIP department. They can help you decide which insurance is best for you.

[kellyscats1]

YEP... i CAN GO ANYWHERE IN THE COUNTRY. Advantage plans are horrible and expensive in the ong run...

[orangecity41 NKF Ambassador in reply to kellyscats1]

Not all are though so have to do the research for what is best for you.

[kellyscats1 in reply to orangecity41]

Yup.. there are many supplement plans so it behoves us to do the research...I opt for the G plan.. most expensive but pays for itself with my care.. and yes goes up every year...

[Marvin8]

"Supplement plans have higher monthly premiums but one your deductible is met.. usually 200 a year everything else is covered at 100% and you are free to see any doctor that accepts medicre which is most every doctor."

Did you mean $2000 instead of $200? $200 sounds crazy cheap.

[kellyscats1 in reply to Marvin8]

my deductible is 230 per year... then all is covered......premiums are 160 a month but once you are diagnosed with ckd unless you sign up as soon as yu are eligible of medicare they will probably deny you.. so get it frm the start

[Marvin8 in reply to kellyscats1]

Are you talking about regular Medicare supplement plans or Medicare Advantage supplement plans? My 65th birthday is two months from now.

[kellyscats1 in reply to Marvin8]

I am referring to what are called advantage pland which Medicare call medicare C plans.. theh are not suppleement plans.. the replace medicare and are managed differently. they are the ones with all the TV ads..Regulare supplement pans are aaalso called Medi Gap plans.. they just cover what medicare does not but are more expensive. Companies like Cigna.. Blue Cross etc sell both. Talk to an agent

[kellyscats1]

That is what I said.. you can be denied a supplement

Medicare alone does not cover 100 % thus the need for a supplement

advantage plans replace paer A and B and are called C... they become more expensive in the long run with co pays.. co insurance and some deductibles and you need a pre auth for everything and can y use your network.. which sadly are not always the best doctors as the reimbursement is low.. advantage pans do not deny you..

The hard part is the suppements do not cover meds and so you need a seperate prescription plan...Good R pays better than my prescription plan an most meds..If the Biden plan passes al seniors will have a 2000 cap on meds for the year.. cross finges

[BlueLe]

are you saying that the first time a person with CKD joins Medicare, some of the supplements can be denied? Please clarify. I am not quite there yet but there are several supplement plans needed.

[kellyscats1 in reply to BlueLe]

When a person with any condition become of age to go on medicare they have an option of selecting a supplement plan.. at that time you cannot be denied for any medical.. pre existing condition nor can they charge you a higher premium.. if you delay and decide to get a cheap advantge plan or strictly medicare and then a year or so or even 6 months later you want a supplement plan you can be denied the supplement plan because of preexisting conditions as when you apply yu fill out a very comprehensive medial questioneer an the check with your docs.. so you have only one shot for good rates on a supplement plan if you say have CKD

There are seeral supplement plans but they all are underwritten

Suggest 6 months bfore you are eligible you speak with a licensed insurance agent ..i signed up 3 mos befor i was eligible

Supplement plans have letters attached like the A plan or the Gplan etc.. it does not matter which company you choose.. All A plans cover the ame.. all G plans cover the same.. be it Cigna or United health etc.. so once you pick a letter you want the least expensive company..then you need a rescription plan.. it is compliated.. sit and talk with an agent

[Blackknight1989 in reply to kellyscats1]

Again not to nitpick but maybe picking the cheapest plan isn’t always the way to go. My recommendation would be if you have current doctors you like and want to stay with us to pick the plan these doctors are members with. Not all doctors sign up with all the Medicare plans. Most do but before picking I’d ensure your current doctors participate otherwise you’ll be unpleasantly surprised at appointment time.

[Coolbeans62 in reply to Blackknight1989]

Another thing to note is that doctors can be removed from your plan for the next year, so it is VERY IMPORTANT to make sure your doctor will still be in your network for the upcoming year if you don't want to look for a new one. If the plan you have is best for your situation, ask your doctor for a physician referral.

[RhenDutchess123]

Yes ...definetly talk to an Agent...navigating Medicare and Supplement Plans are so complicated...and designed that way..for a reason

[Blackknight1989]

For me that is not the case currently. I have been on both projects care plans that I bought as a small business owner and the “government” plan I am on currently. In the two years I have been on this current plan I have no issue seeing other doctors. In fact I just fired my current nephrologist because he insisted I have diabetes when I do not. He became confused when I asked for Jardiance to help slow my CKD progression during my last appointment. As I attempted to reschedule my follow up appointment with the nurse she informed me I had diabetes, I told her that was incorrect and the argument began. Some doctors do not like to be contraindicated especially by patients. I have had stage 4 CKD since 1996 and luckily the initial nephrologist I had was absolutely the most competent I’ve ever had. Unfortunately I moved towns in 2003 and could not continue to see him but I do credit him with saving my life. As such it would be my strong suggestion to ensure your Nephrologist is the best you can find. Due to being in the Army I’ve moved often and had several of varying abilities. As such and because I do significant research I have learned to evaluate each and decide if they can offer me with ab eGFR of 10-17 enough support. If they cannot I change and I firmly believe you just take this action yourselves as I believe if you have CKD as I do an incompetent nephrologist can end your life earlier than it should be where a competent nephrologist can extend quality of life significantly. As such I recommend you spend time daily researching your disease because significant CKD (stage 3 or worse) will or should affect EVERY decision your doctor makes regarding caring for your specific disease. CKD should be thought of by both doctors and patients as a diagnosis as significant as that of an advanced stage of cancer. Unfortunately by many of both it is not. Because it’s progressive that shortens lifespans of patients who do not address it immediately. While true that currently treatment prior to dialysis is still limited the approval of both Farxia and Jardiance have both just been recently approved by the FDA (in the US) so finally the needed research is being conducted at a much faster rate and without a competent doctor willing to keep up with the changes occurring much faster than they have grown used to over their careers, their patients care can suffer. So the decision to deal with your diagnosis as soon as diagnosis can and most likely will play a huge role in your ultimate outcome.