Medicare Supplement Plans/Extend Health

[kaneohe]

Megacorp has decided that it doesn't want to do its own self funded health
plans for retirees anymore. Instead they will be offering a fixed (forever, not indexed for inflation)cash reimbursement to help pay for plans that we have to find on the open market or through Extend Health, a benefits advisor that they have contracted with to help (they actually call themselves a health exchange).

In the early stages of confusion.......I understand that the Medicare supplement plans have to be "identical" between different suppliers (for a given "letter" plan.). If that is true and the only difference is price, what are the possible disadvantages of going w/ the lowest cost supplier........besides customer service? Aren't all the coverages, coinsurance, etc. the same for a given letter plan?

I also saw this chart http://www.caring.com/comparison_charts/medigaptable.pdf

It appears to say that I cannot have both a max out of pocket cap and also coverage for foreign emergencies in a single policy. True? I didn't see anything
about lifetime maximums.

For a given letter plan and supplier, if I get it on my own vs getting it from Extend Health, which will be cheaper

I tried to get some questions answered by Extend Health but, like all customer service orgs, the service can be highly dependent on the individual you speak to and it sounds like I'm going to have to do the
usual "call N times until you get a statistically significant answer".
Evidently N=3 is not enough.

 

[westcoast]

Medicare F offers better coverage than Medicare C. Hospitalization and labs are 100% covered. The supplement will handle the deductibles and the parts of doctor fees (20% of fee schedule) that Medicare doesn't pick up. Medicare F picks up balances from doctors who don't accept Medicare assignment and pays for more days in skilled nursing.

 

[MichaelB]

Here is a link to Medigap info http://www.medicare.gov/publications/pubs/pdf/02110.pdf

It seems there is no max OOP when foreign coverage is included. The difference between policies is not just cost, it is network access. An insurance company can offer a policy with a lower premium by limiting coverage to a smaller network of providers and making the insured person liable for a greater percentage of the cost when services are provided outside of that network.

 

[kaneohe]

MichaelB........thanks for pointing out the network feature. That's the same link I was looking at but I had just skimmed it and ignored the SELECT topic as being a specialized item. I thought I had read that there was no network for Supplement plans.........just as long they they accepted Medicare which was most. SELECT sounds like a PPO.

westcoast.........thanks also for your comments. Now I'm confused because I just read in that link that F had a high deductible option which would seem like coverage was less. Maybe it's just an option and you're talking about the non-option F?.........got a lot more homework to do.

 

[REWahoo]

westcoast.........thanks also for your comments. Now I'm confused because I just read in that link that F had a high deductible option which would seem like coverage was less. Maybe it's just an option and you're talking about the non-option F?.........got a lot more homework to do.

Yes, supplement F has both a 'regular' plan and a high option plan.

I'm within a few months of going on Medicare and I'm going through the same process to try to figure out the best option for me. At the moment I'm leaning towards the high-deductible version of F.

 

[Moemg]

My SO is turning 65 this month so I have been studying the plans . The problem IMO with the Medigap plans is you still do not have drug coverage . There are also Medicare Advantage plans which do include drugs but you do have some deductibles . Medicare Advantage is basically Medicare run by insurance companies . The ones that IMO offer the best value are the regional PPO's .If you go to the Medicare site it can tell you what plans are available where you live . Some of the plans have zero cost . Well it is zero above the amount taken from your SS check for Medicare Part B . Before I picked a plan I checked out the Physicians in it to be sure he would have adequate coverage . I also asked Medical billing offices which plan they would recommend . ( It helps to have medical connections ).Medicare does send a large booklet three months before you are eligible or you can access it by going online to medicare .

 

[kaneohe]

Yes, supplement F has both a 'regular' plan and a high option plan.

I'm within a few months of going on Medicare and I'm going through the same process to try to figure out the best option for me. At the moment I'm leaning towards the high-deductible version of F.

Is it your impression that only K & L have max out of pocket limits?

 

[REWahoo]

I looked into the Medicare Advantage plans in my area and they do look interesting. Unfortunately my primary doc does not participate in any of the advantage PPO plans so I'm leaning towards going with Medicare, a high-deductible medigap plan, and the lowest-cost Part D (drug) coverage I can find. I take no prescription meds and will enroll in Part D now only to prevent paying a penalty and facing a waiting period to enroll some time in the future. BC/BS has a plan for $15 a month that should do the trick.

 

[REWahoo]

Is it your impression that only K & L have max out of pocket limits?

Yes, only those two according to this chart: Medicare.com - Medigap Plan Benefits Chart

 

[TN_INVEST]

F plan is a nice choice. As you have already noticed, you can also shop around for prescription drug plans, whereas a lot of the Advantage plans link the health insurance part with the drug plan, which I don't particularly like (I'd prefer to cherry-pick the "best" drug plan and have the option of changing the drug plan as things change through the years).

About the only thing to worry about with going with the lowest cost F plan provider is that the premiums might increase a bit faster over time, and that could end up costing you down the road (cheaper at 65, but more expensive at 75).

Medicare came out with a couple new plans a couple years ago (I think M&N) that have lower premiums, but those require some co-pays and/or deductibles (which might be fine for folks that are healthy and want to lower their premiums even further.

The way I look at it, there is something real nice about getting "full coverage" with the F plan.

Regarding the Advantage plans: I'm not a big fan. I don't really care for all the HMO/PPO "in network" stuff (we had a couple large doctor groups and hospitals in the area that had some contract issues with one of the larger Advantage plans to the point they pretty much opted out).

 

[Moemg]

Regarding the Advantage plans: I'm not a big fan. I don't really care for all the HMO/PPO "in network" stuff (we had a couple large doctor groups and hospitals in the area that had some contract issues with one of the larger Advantage plans to the point they pretty much opted out).

The thing that swayed me to the Medicare Advantage plans was seeing how well the Federal Government has done managing things especially health care . There is a huge difference between a PPO & an HMO . I would never recommend an HMO except for someone who needed health insurance at the lowest possible cost .

 

[kaneohe]

The thing that swayed me to the Medicare Advantage plans was seeing how well the Federal Government has done managing things especially health care . There is a huge difference between a PPO & an HMO . I would never recommend an HMO except for someone who needed health insurance at the lowest possible cost .

Somehow I got the impression that the Advantage plan was an HMO-like entity. That's not correct?

And folks picking supplement plans not worried about not have an out of pocket max?

 

[REWahoo]

Somehow I got the impression that the Advantage plan was an HMO-like entity. That's not correct?

I think they can be either a PPO or an HMO, it varies by the insurer offering the plan.

 

[Moemg]

Somehow I got the impression that the Advantage plan was an HMO-like entity. That's not correct?

The different companies have both HMO's which are dirt cheap and PPO's that are a good value . One of the best values are the regional PPO's especially for people that are basically in one area .They vary in the maximum amount out of pocket but it usually around $4,500.The plans all have ratings so you can check them out . You can also google the plans for consumer complaints. If you have a complicated health history or your Physicians are not members than a Medigap policy is the way to go with an added drug plan IMO.

 

[MichaelB]

The different companies have both HMO's which are dirt cheap and PPO's that are a good value . One of the best values are the regional PPO's especially for people that are basically in one area .They vary in the maximum amount out of pocket but it usually around $4,500.The plans all have ratings so you can check them out . You can also google the plans for consumer complaints. If you have a complicated health history or your Physicians are not members than a Medigap policy is the way to go with an added drug plan IMO.

Medicare Advantage plans can be a good value, especially for seniors with limited income and health care needs. They do receive a subsidy from Medicare, and this is being phased out, so they may become "less of a value" in a couple of years. Even without subsidy, however, they still should continue to be viable options for people willing to accept some limitations and in return pay less for health care.

 

[easysurfer]

I suppose it all depends on your health and what you can afford. Friend of mine has the F plan and she wouldn't go without that coverage. Nice that pretty much what medicare doesn't cover, she knows it's covered by the supplemental plan.

 

[JOHNNIE36]

I think they can be either a PPO or an HMO, it varies by the insurer offering the plan.

You are correct. A Medicare Advantage Plan may offer both HMO and PPO coverages. Like most, I prefer the PPO. We are with Secure Horizons by United Health Care. They have the AARP credential affixed but United is just paying AARP to use their name. There is no affiliation. Again, the plan depends on what's available in your area and this information is available on the Medicare.gov website. All of our doctors and surgeons belong to the Secure Horizons plan, all the hospitals and labs in my area are in the plan. It has a mail order prescription drug plan and basic dental like cleanings and exams. We continue to pay the Medicare premium and that is all. Sure, there are deductible and copays and the maximum OOP is still $4500/yr. Copay is $1 for an office visit to primary care physician (you have to pick one), $30 for specialists. I just hate paying premiums for something you may never use. Others feel the opposite. They would pay up front and not have to worry about the nickle and dime stuff.

 

[TN_INVEST]

The thing that swayed me to the Medicare Advantage plans was seeing how well the Federal Government has done managing things especially health care . There is a huge difference between a PPO & an HMO . I would never recommend an HMO except for someone who needed health insurance at the lowest possible cost .

Everybody has to choose for themselves and you can make a good case that some of the Advantage plans offer a good value (some have dental, vision & health club reimbursements and there are some with $0 monthly premiums).

However, let's not forget that there seems to be somewhat of a push for the government to control healthcare (Hillary care, Obama care, etc.). IMHO, that seems that they might provide a little more headwind to the private company Advantage plans and therefore many of the Advantage plans will have to reduce benefits or raise premiums because they lost some of their subsidies (pretty easy for them to say they are going to reduce private company subsidies because the private companies are greedy).

If anything happens with the F plans, history shows that they simply grandfathered folks in with their current plans, stopped taking new enrollees, and rolled out some new plans (I think we are up to M & N now).

Cuts to Medicare Advantage Plans - YouTube

Obama: Let's Take Away Supplemental Insurance for Seniors & Give it to Families - YouTube

 

[Moemg]

Everybody has to choose for themselves and you can make a good case that some of the Advantage plans offer a good value (some have dental, vision & health club reimbursements and there are some with $0 monthly premiums).

However, let's not forget that there seems to be somewhat of a push for the government to control healthcare (Hillary care, Obama care, etc.). IMHO, that seems that they might provide a little more headwind to the private company Advantage plans and therefore many of the Advantage plans will have to reduce benefits or raise premiums because they lost some of their subsidies (pretty easy for them to say they are going to reduce private company subsidies because the private companies are greedy).

Absolutely and I considered that when looking at all the plans . They cannot change the plan for the year you signed up and if you are unhappy with the plan you get the option of changing once a year .

 

[kaneohe]

................ and if you are unhappy with the plan you get the option of changing once a year .

I am interested in learning about this aspect also.......the quick skimming that I did gave me the impression that, at least when changing from supplement to supplement, it may not be this simple and that underwriting (pre-existing conditions) could lock you into your current plan which would make it all that more important to pick wisely the first time.

Can anyone confirm that this is correct or not. Also how about the other 3 combinations:
2) supplement to Advantage
3) Advantage to Advantage
4) Advantage to Supplement?

 

[REWahoo]

I am interested in learning about this aspect also.......the quick skimming that I did gave me the impression that, at least when changing from supplement to supplement, it may not be this simple and that underwriting (pre-existing conditions) could lock you into your current plan which would make it all that more important to pick wisely the first time.

Can anyone confirm that this is correct or not. Also how about the other 3 combinations:
2) supplement to Advantage
3) Advantage to Advantage
4) Advantage to Supplement?

This will answer some of your questions: Medicare Part C - Medicare Advantange Plans

Scroll down to "A Few Extra Things You Should Know about Medicare Advantage Plans"

 

[kaneohe]

Thanks for that link, REW. I must admit I'm still confused........
when you switch to original Medicare, does that imply you can also get
a supplement in addition? Are there other times of the year that you can
switch (is there an open enrollment period when you can switch Advantage Plans, or to Supplements? The link makes it sound like the short period
in 2011 is a special one time only or does it occur every yr? Clear as mud to me and it's no where close to midnight yet.


The Linked Article
A Few Extra Things You Should Know about Medicare Advantage Plans
New—Making changes to your coverage after December 31 Between January 1–February 14, 2011, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

During this period, you can’t do the following:

Switch from Original Medicare to a Medicare Advantage Plan.
Switch from one Medicare Advantage Plan to another.
Switch from one Medicare Prescription Drug Plan to another.
Join, switch, or drop a Medicare Medical Savings Account Plan.

 

[Nords]

I've been working up a blog post on Medicare supplemental insurance for military retirees.

From the blissfully ignorant view of a military retiree down here in my 50s, you'd think that at age 65 Medicare part "B" and the military's Tricare For Life would take care of all one's medical needs. However I'm hearing that some retirees are covering their gaps with VA benefits. Others are looking for coverage for hearing aids, respiratory issues, and maintenance medications.

Still more are subject to the media's "fear, uncertainty, & despair" campaigns that drive them toward supplemental insurance policies offered by MOAA and AARP. Yet as near as I can tell those supplemental policies are just designed to ensure that a retiree has absolutely zero out-of-pocket costs... not even for doctor-visit co-pays or prescription co-pays. Meanwhile the cost of the premiums may very well be higher than the potential cost of the co-pays.

If any of you "more experienced" military retirees have advice about accessing Medicare & TFL, and whether or not supplemental insurance is necessary, I'd be happy to quote you on it.

 

[REWahoo]

kanehoe, you can find all the answers here: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

Take a look at page 68.

 

[MichaelB]

Thanks for that link, REW. I must admit I'm still confused........
when you switch to original Medicare, does that imply you can also get
a supplement in addition? Are there other times of the year that you can
switch (is there an open enrollment period when you can switch Advantage Plans, or to Supplements? The link makes it sound like the short period
in 2011 is a special one time only or does it occur every yr? Clear as mud to me and it's no where close to midnight yet.


The Linked Article
A Few Extra Things You Should Know about Medicare Advantage Plans
New—Making changes to your coverage after December 31 Between January 1–February 14, 2011, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

During this period, you can’t do the following:

Switch from Original Medicare to a Medicare Advantage Plan.
Switch from one Medicare Advantage Plan to another.
Switch from one Medicare Prescription Drug Plan to another.
Join, switch, or drop a Medicare Medical Savings Account Plan.

You have to enroll in medicare in the 3 month period before you turn 65. To enroll in a Medicare Advantage plan you have the same 3 months plus an additional 4. One you enroll in a plan, you can change by enrolling in a new plan, once per year sometime in the last 3 months (not sure of the exact dates)