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What Medicare plan & supplemental protects best for fewest out-of-pocket suprises
Old 08-24-2013, 10:36 AM   #1
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What Medicare plan & supplemental protects best for fewest out-of-pocket suprises

Would like to to get some hints to share regarding a person's current choices for Medicare healthcare coverage. I'm told this person has Medicare A (and probably B) ?

From what I understand (very little), he is on a United Healthcare Complete (no premium, includes prescription coverage, could be a PPO or ?) which precludes him from being covered by an AARP Medicare supplemental plan. (Does anyone know if this is true?)

He is in excellent health for his age, but does "not" have the bucks to pay 20% of a hospital bill, or for the co-pay for a short stay in a rehab facility (for example) should either of those be needed. There is some long term care insurance in place.

Called AARP and from person on the phone I get the idea that a good supplemental plan is around $195 per month, and it will pay what Medicare does not pay for a hospitalization or short term rehab stay.

So I welcome any hints or input from the forum on what Medicare plan his relatives should explore for him "instead" of this United Healthcare Complete and what supplemental should be put into place so he's covered as much as possible.

And, can it be changed now or is there some sort of open season for changes?

Is there something to read that actually makes it all easy to understand or is this too much to hope for?

I don't have much information beyond what I have posted - so I don't know if I'm even asking the right questions. I will pass the information or references along to the other relatives helping him. Thanks for any input.

Kindest regards.
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Old 08-24-2013, 01:20 PM   #2
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Quote:
Originally Posted by spncity View Post

And, can it be changed now or is there some sort of open season for changes?

Is there something to read that actually makes it all easy to understand or is this too much to hope for?

I don't have much information beyond what I have posted - so I don't know if I'm even asking the right questions. I will pass the information or references along to the other relatives helping him. Thanks for any input.

Kindest regards.
Medicare puts out a booklet which is easy to understand and explains all the different options . I believe you can also view the booklet online .It sounds like he had a Medicare advantage plan . They are complete plans so you do not need a supplement with them . There Are various Medicare Advantage Plans and depending on what you pay how much is covered.
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Old 08-24-2013, 01:54 PM   #3
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spncity, I am almost certain he has a Medicare Advantage plan called Secure Horizons by United Health Care. This plan has the AARP nametag but has nothing to do with the plan. United pays a fee to AARP to use their name and make everything sound better. I was with this United Advantage plan for two years and it treated us good. No problems. In 2012 they increased their copays and deductibles so I switched us to BCBS Medicare Advantage. With both of these plans, along with others, there is no premium in addition to your Medicare insurance premium ($105/mo??).
All of the plans available are listed on the medicare.gov website.

Regarding the idea of going back to Medicare: I checked on this and found out that you can go back to plain old Medicare anytime; however, you may not be able to purchase a supplemental plan. That would be up to the issuer of the supplemental plan. My BIL has researched this for years and rechecks all the time. He says that all the supplemental plans have letter designations (such as Plan F) and each supplemental plan must provide the same coverage across the country. The only difference is the price. EX: He has regular Medicare and supplemental Plan F. So he shops for the best price on Plan F. For 2013 the best price was Mutual of Omaha, so that's what he bought. I think he said it was $105/mo.

About going back and forth: I probably couldn't go back as most likely an insurance company wouldn't sell me a supplemental plan because of preexisting conditions. That may change with Obamacare as they aren't supposed to hold that against you. I'll believe that when I see it. I may not change back regardless, but it would be nice to have that option.

Hope this helps and if anyone has more information I'd like for you to post also as this is a big concern for everyone. The more information the better.

Edited to add that prescription drugs are covered by most Advantage Plans but price per drug changes every year. Some of mine are even free for a 90 day supply. The Advantage Plans are "advantageous" and that is why they are always targeted for cuts by the government. A lot of older people have those plans and that is why the government treads lightly.
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Old 08-24-2013, 02:54 PM   #4
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I think Johnnie36 has summed it up pretty well......at least my understanding is the same as his........that you can more easily migrate "downstream" from (Medicare + Supplement) to Advantage than the other way around which will probably require underwriting (qualifying via medical tests). Medicare + Supplement F will cover most everything (I'm sure there are some exceptions) but you probably end up paying more in premiums in return.
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Old 08-24-2013, 05:22 PM   #5
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Very helpful - I will look up the references.

In reviewing the notes, I see I should have posted the full name: United Healthcare MedicareComplete Choice (Regional PPO). There is no space between the words MedicareComplete. There is no premium for this plan or the prescription coverage (sounds like higher income would require a prescription premium - but income is very low in this case).
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Old 08-24-2013, 06:18 PM   #6
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Very helpful - I will look up the references.

In reviewing the notes, I see I should have posted the full name: United Healthcare MedicareComplete Choice (Regional PPO). There is no space between the words MedicareComplete. There is no premium for this plan or the prescription coverage (sounds like higher income would require a prescription premium - but income is very low in this case).
Sorry for my error, but to correct, our plan was called: AARP United Health Care Medicare Complete Secure Horizons (Regional PPO). Right, no premium except for the normal Medicare premium that comes out of your SS every month. Prescription coverage was included. Also, some dental and vision. As mentioned in my earlier post, there are deductibles and copays. Every Advantage Plan will be a little different and that is why I changed to BCBS Medicare Advantage in 2012. Who knows, I might change again in 2014. The fine print in Obamacare may change everything.
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Old 09-02-2013, 08:26 AM   #7
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I have Physicians Mutual, $180.00, what I like about it, it pays for preventative care, blood tests, exams, tests etc. This is there best and most expensive plan. I had United Health Care and they constantly reject my claims. Claim tests are diagnostic and not wellness or included in a physical, or not preventative. UHC was way more expensive also.
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Old 09-02-2013, 04:07 PM   #8
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I have Physicians Mutual, $180.00, what I like about it, it pays for preventative care, blood tests, exams, tests etc. This is there best and most expensive plan. I had United Health Care and they constantly reject my claims. Claim tests are diagnostic and not wellness or included in a physical, or not preventative. UHC was way more expensive also.
lynxville, when you quote a health care plan, you have to be very specific as United Health Care has many plans. They probably offer at least a dozen, all with different names.
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Old 09-03-2013, 06:50 AM   #9
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lynxville, when you quote a health care plan, you have to be very specific as United Health Care has many plans. They probably offer at least a dozen, all with different names.

UHC Choice $272 per month Besides my past employer paying 25% or $68.00 with a total cost $340 for one person.
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Old 09-03-2013, 08:57 AM   #10
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It's been my experience that regardless of the plan (e.g. Original Medicare with one of the 11 Gap Plans together with Part D or an Advantage Plan, which includes Drug) you can pay less and have higher deductables and co-pays or pay more and pay less costs - such as for doctor's visits.

It's the old story of "pay me now or pay me later".

Depending on your current health, you could decide to go with a $0 cost Advantage plan or a low cost Gap plan or if you frequent the doctor(s), pay up front and don't worry about the charges every time you visit your PCP or specialist.

As in most things in life, it all depends on your spectific need, based upon your specific health and financial situation...
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Old 09-07-2013, 07:46 AM   #11
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I appreciate on-going comments.

The need, in this case I believe, is to find the best thing that would cost in the range of $200-$300 per month (A known investment) that leaves the fewest surprise costs, should he need additional prescriptions, or have a hospitalization, or short-term stay in rehab nursing home if he were to have a fall and break something.

It would be nice if it had some dental coverage for cleaning and checkups.

They are fine having prescription co-pays, but not wanting that donut hole thing.

So - if they have him go away from the UHC MedicareComplete Regional PPO to regular Medicare plus supplemental - do you recommend something called Plan F?

Kindest regards.
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Old 09-07-2013, 11:07 AM   #12
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DH has Plan F which covers the Medicare deductible and all the co-pays. Also, if a provider charges more than Medicare will pay this will pick that up (that said, most providers don't do that so it doesn't come up that often). There is a plan that is similar but doesn't cover the deductible (forget which one it is) but for him the reduction in price of that plan didn't make it worthwhile.

The other thing that is needed, however, is a prescription drug plan which is separate from your regular supplement plan.

DH has the United Healthcare prescription drug plan which he got through AARP (in his case, if he chose that plan the megacorp he retired from would pay the premium so it made sense to do it particularly since he doesn't have any regular prescriptions).
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Old 09-07-2013, 11:24 AM   #13
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Okay - so he needs three things:

1. Regular Medicare (fee deducted from social security check, yes?) He has A and B

2. AARP Supplemental Plan F (around $195 per month)

3. Prescription plan (what's the best coverage so that he will just have co-pays, no donut hole, no big out-of-pocket surprises and WHAT IS THE ESTIMATE FOR THIS?)

4. What is Medicare D ?

Keep comments coming! Thank you!
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Old 09-07-2013, 11:48 AM   #14
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Originally Posted by spncity View Post
Okay - so he needs three things:

1. Regular Medicare (fee deducted from social security check, yes?) He has A and B

2. AARP Supplemental Plan F (around $195 per month)

3. Prescription plan (what's the best coverage so that he will just have co-pays, no donut hole, no big out-of-pocket surprises and WHAT IS THE ESTIMATE FOR THIS?)

4. What is Medicare D ?

Keep comments coming! Thank you!
Supplemental Plan F cost depends on age and type of plan chose. DH has the AARP plan which is community rated. He pays about $155 a month but he is still 65. He currently has a discount due to age and it will go up.

Medicare D is the prescription drug benefit which is where you get your prescription plan. Don't know the answers to questions on best prescription program since he just did the United Healthcare one since megacorp was paying.

I helped my mom a few years ago find her prescription plan. I went to somewhere (don't recall where) and filled in her regular prescriptions (she has a bunch) and then got results as to what would be covered on which plan.
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Old 09-07-2013, 12:06 PM   #15
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If you go to the medicare.gov website, you will find links to help you find a plan
https://medicare.gov/find-a-plan/questions/home.aspx

You can do a general search by putting in the medications of interest and the finder wil retrieve available plans and order them by cost....lowest first.
If there are no current medications , you can either become a psychic and predict which ones will be needed, or just choose the cheapest current plan.......planning to change later if necessary......probably should review plans every year anyway.
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