2012 Medicare Advantage changes

[mf15]

Wife just got her book, what I see changing so far is.
$5 a month cost increase,no big deal.
Instead of $45 copay for complex imaging it is now 20% of cost, that could get expensive. Have to see what they classify as complex imaging.
And the kicker is.
Yearly out of pocket went from about 3500 to 7000, wow double.
By 2014 when the changes really kick in, medicare advantge plans may no longer have any advantage.
Old Mike

[rescueme]

Each Advantage Plan is managed (cost/coverage) by a commercial provider. It is not part of traditional Medicare, and your plan's results are dependent on your own policy.

While the Advantage Plan provider (in your case) may not cover what you feel is important to you, it may be time for you to review from other AP providers in your area.

Not all AP plans are created equal, and the reason I changed providers last year.

[JOHNNIE36]

I posted on another thread the fact that I inquired about changing back from our Medicare Advantage plan to the basic Medicare and a supplemental plan. I can go back to Medicare but can't get a supplemental plan because of preexisting conditions. Had a heart attack back in 2004 and the related coronary bypass. Add total knee replacement, Abdoninal Aortic Aneurysm stent graft and rotator cuff surgery and I guess I wouldn't take me either. Everything has gone up in the coverage booklet and the maximum out of pocket has gone to about $7500. At least there is no premium so I guess we get a lot of coverage for the money.

[haha]

Quote:

Originally Posted by JOHNNIE36 I posted on another thread the fact that I inquired about changing back from our Medicare Advantage plan to the basic Medicare and a supplemental plan. I can go back to Medicare but can't get a supplemental plan because of preexisting conditions. Had a heart attack back in 2004 and the related coronary bypass. Add total knee replacement, Abdoninal Aortic Aneurysm stent graft and rotator cuff surgery and I guess I wouldn't take me either. Everything has gone up in the coverage booklet and the maximum out of pocket has gone to about $7500. At least there is no premium so I guess we get a lot of coverage for the money.

Did you have all that work done on your MA plan? If so, I think you must be quite a bit ahead still.

Ha

[JOHNNIE36]

Quote:

Originally Posted by haha Did you have all that work done on your MA plan? If so, I think you must be quite a bit ahead still. Ha

No, only the rotator cuff surgery was done under the Advantage plan and it went well financially. It was done as an outpatient sameday surgery, my cost was about $250 for the surgery center, $300 for the surgeon and the physical therapy cost me about $350. Then I quit going. The other surgeries were done under Medicare and my Blue Cross/Blue Shield supplement.

[westcoast]

Quote:

Originally Posted by JOHNNIE36 I can go back to Medicare but can't get a supplemental plan because of preexisting conditions. Had a heart attack back in 2004 and the related coronary bypass.

As I understand it, preexisting conditions are not a consideration for Medicare supplements (if you have had "creditable coverage" for at least six months prior to the switch). There are periods for enrollment, one of which is around your birthday.

Search <medicare supplements preexisting conditions>

[kaneohe]

Quote:

Originally Posted by westcoast As I understand it, preexisting conditions are not a consideration for Medicare supplements (if you have had "creditable coverage" for at least six months prior to the switch). There are periods for enrollment, one of which is around your birthday. Search <medicare supplements preexisting conditions>

Could you provide your specific reference for this? I have a feeling that it may apply to a different situation. My impression is that you can swim downstream from supplements to advantage plans but not so easily upstream.

Perhaps you are referring to this (p.14 of the link below):
When is the best time to buy a Medigap policy?
The best time to buy a Medigap policy is during your Medigap open enrollment
period. This period lasts for 6 months and begins on the first day of the month in
which you’re both 65 or older and enrolled in Medicare Part B. Some states have
additional open enrollment periods including those for people under 65. During
this period, an insurance company can’t use medical underwriting. (note added:
this is a ONE time open enrollment period)

I found this http://www.medicare.gov/publications/pubs/pdf/02110.pdf

There are some tables on p. 22-23 and then on p. 35

What happens to my Medigap policy if I join a Medicare Advantage Plan?

................. However, if you leave the Medicare Advantage Plan you might not be able to get the same Medigap policy back, or in some cases, any Medigap policy unless you have a “trial right.” See page 23.

[westcoast]

Quote:

Originally Posted by kaneohe Could you provide your specific reference for this?

See p. 33 in the document you cited: http://www.medicare.gov/publications/pubs/pdf/02110.pdf

Do I have to wait a certain length of time after I buy my first
Medigap policy before I can switch to a different Medigap policy?
No. You should be aware that if you’ve had your old Medigap policy for less
than 6 months, the Medigap insurance company may be able to make you
wait up to 6 months for coverage of a pre‑existing condition. However, if
your old Medigap policy had the same benefits, and you had it for
6 months or more, the new insurance company can’t exclude your
pre-existing condition. If you’ve had your Medigap policy less than
6 months, the number of months you’ve had your current Medigap policy
must be subtracted from the time you must wait before your new Medigap
policy covers your pre‑existing condition.

If the new Medigap policy has a benefit that isn’t in your current Medigap
policy, you may still have to wait up to 6 months before that benefit will be
covered, regardless of how long you have had your current Medigap policy.
If you have had your current Medigap policy longer than 6 months and
want to replace it with a new one with the same benefits and the insurance
company agrees to issue the new policy, they can’t write pre-existing
conditions, waiting periods, elimination periods, or probationary periods
into the replacement policy.

[kaneohe]

westcoast..........the reference you gave refers to a supplement to supplement change. Johnnie36, I believe, is talking about a contemplated Advantage to supplement change which , I think, is more difficult.

[donheff]

Quote:

Originally Posted by kaneohe westcoast..........the reference you gave refers to a supplement to supplement change. Johnnie36, I believe, is talking about a contemplated Advantage to supplement change which , I think, is more difficult.

It is all academic to me but when the Advantage plans were first instituted I vaguely remember thinking that a switch to an Advantage plan sounded risky for this reason. I thought the AHCA took away the taxpayer funded advantage to the Advantage plans - did the law also offer a path back to Part B?

[JOHNNIE36]

Having read all the posts, I don't see any way that I could force any insurance company to sell me a supplemental health insurance plan. I can't find anything in the Medicare publications that says I can do this. Westcoast, I'm 75 with preexisting conditions and have my Advantage plan for two years. I would like to find out if anyone has heard of any insurance company that has/would offer a policy to someone with preexisting conditions?

[mf15]

Here is a link that explains the trying to switch back to medagap from advantage. It looks like you can it an insurance company will take you, if after your trial period. This is from 09, it seems now the the government has changed the game with medicare advantage they should also change the law to let you switch back,easily.

Switching From a Medicare Advantage Plan to a Medigap Policy | California Health Advocates

Here is the actual medicare PDF,look starting around page 23.
http://www.medicare.gov/publications/pubs/pdf/02110.pdf

Old Mike

[rescueme]

Another current article on the subject relating to the current enrollment period:

Medicare Enrollment Checklist

[mf15]

Talked with Aetna rep yesterday, my wife has no pre existing conditions, so the way to switch to medigap from advantage is in december, you have to show intent to opt out of advantage, and then schedule the medigap to kick in January 1st. Otherwise there is a month gap in coverage, not sure why this is. Will have to study all the plans again, since I last looked at them two years ago. I am not likeing the trends I am seeing in at least the Aetna medicare advantage plans.
Old Mike

[Moemg]

My SO has a Medicare advantage plan . It's a local plan Universal Advantage . The changes for 2012 are minimal . He is basically very healthy . He takes no medications and his medical history is minimal . Last night we spent in the ER for a kidney stone . ER cost $50. He left with 4 prescriptions . Cost for prescriptions $0. I still think the Advantage plans are great for people with minimal health history .