Turning 65. Looking for help and advise on employer provided UHC Group Medicare Advantage PPO plan.

calnomore

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Hello,
I will be turning 65 later this year. DW will turn 65 in April 2026.
We've been on her previous employer's provided BCBS 80/20 plan since she retired from the Federal Reserve Bank in 2016. The premiums and deductibles are very reasonable. But the time is coming to get off.
The FRB offers the over 65 retires and spouses UHC Group Medicare Advantage PPO and prescription drug plan.
There is a lot of info about advantage plans and the downside but does a plan like this fall into the same category. The FRB has always offered great benefits.
Here are some particulars:
The cost is $77 per month for each of us.
Annual medical deductible $0
Annual out-of-pocket maximum $1, 000
Office and clinic visits $15 copay
Hospital services (inpatient) $100 copay
Hospital services (outpatient) $50 copay
Prescription drug coverage Tier 1: $7 copay
Tier 2: 30% coinsurance up to a max $45
Tier 3 & 4: 30% coinsurance up to a max $50

Any help and advise would be greatly appreciated!
 
Employer provided Advantage plans are a different animal than those available to the general public on the market. They are usually quite robust. I have been on my employer provided retiree Advantage plan for 6 years and have zero complaints regarding the coverage/payments. Your plan sounds excellent.
 
Thank you for your encouraging reply.

Wondering if anyone else has any experience or comments?
 
I have no experience with this plan, and as MissM correctly points out, employer plans are unique and difficult to compare. My mum had an employer sponsored UHC MA PPO plan for her retirement for a couple of years and I found it quite comprehensive. The provider network was robust and nationwide, and the drug coverage was very good.

Be aware that the employer can drop or change the plan without notice. I doubt the FRB would do that, but it is something to keep in mind. (My mums employer has changed plans three times, each time downgrading the benefit).

The drug coverage posted by the OP looks reasonable and the total OOP is low. It looks like a reasonable option.
 
I'm very familiar with the FRB UHC Medicare Advantage plan. My suggestion is you should keep it and ignore any other plans you see advertised or part D. The plan is greatly subsidized by the FRB, so at the end of the day, you're paying for just part of the coverage versus completely paying for any of the other alternatives in the marketplace.

Subsidy example: (Costs vary somewhat by District) In 2024, a 65 year old retiree + spouse would've paid $120 total per month, $1,440 per year in premiums. The FRB paid in an additional premium of $306.58 per month, 3,678.96 per year. The FRB paid close to 72% of the plan premium, while the retiree paid a little over 28% of the premium.

Yesterday, there was a thread here about the high cost of Paxlovid. The poster had paid a handsome sum for it, I think on Medicare part D. The replies varied in terms of the cost of Paxlovid on their plans, with some mentioning meeting their $1,000 annual deductible. Alarmed that the cost of Paxlovid was so high, today I checked the UHC Medicare Advantage plan. If you needed the drug there's no deductible. Even though it's a tier 4 drug in the formulary, if you look up the specific drug cost on the site, the cost is $0. I think that extra benefit of no cost was added early in the pandemic for Covid related drugs.

No annual deductible and $1,000 out of pocket maximum are great benefits. The plan compares fairly close to the most expensive FRB employee health plan. If I recall UHC had a 100%, no deductible plan, while your BCBS plan might be 90% with a deductible (details vary by District). Optumrx mail order for 90 day prescriptions is also a part of the plan.

Since most of the senior career FRB officials will someday be on this plan, I expect it to remain a good benefit.
 
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Thanks for the great replies especially the in depth specifics by gromit.

Just curious gromit are you on this plan?
I've read that some plans give you money towards your part B. Do you know if this one does?
 
I have seen several recent stories about health plans that will no longer take UHC Advantage insurance, leaving group holders adrift. The issues are very high denial rates on pre-approvals and stonewalling on appeals, both of which tie up health plans' staff far beyond the rates they see with other insurors.

Given all the other comments my guess is that you'll just have to go with them and hope that denials don't become an issue.
 
DW is (and I will be) on my Megacorp's PPO with UHC and we have not had any issues. Our deductibles are slightly higher than yours, but our total plan cost (employer/pensioner) is slightly less. As others have indicted, our plan is unique and limited to Megacorp pensioners. I have heard the comments about PPO denials, etc., but only from friends/individuals that aren't actually on our plan. Because the folks negotiating these plans with UHC will be on the plan themselves in a few years, I don't worry too much about it being an Advantage PPO plan.

Full disclosure, I don't really understand the medicare advantage plans, but then who does. ;)
 
We have this plan through my former Megacorp. We are starting the third year of the plan. All of our pre-Medicare doctors accept the plan. We have yet to find a doctor/facility in our area that does not accept it. We have not had any denials, but so far nothing more serious than fractured ankle (DW), cataract surgery (DW), and testing for prostate cancer (me). They did not cover some aspect of the cataract surgery, but we knew that going in. We have had no major dental issues, but reimbursement for dental, annual vision tests, and eyeglasses has gone smoothly. Only one of my medications is not fully covered.

Your premiums and co-pay are less than ours, but our out-of-pocket is less.

So... so far, no complaints.
 
Thanks for the great replies especially the in depth specifics by gromit.

Just curious gromit are you on this plan?
I've read that some plans give you money towards your part B. Do you know if this one does?
Yes, I'm on the plan. No, it does not provide any assistance toward paying your part B.
 
I'm on the plan and have used it extensively. My cancer treatment was fully covered. I had PET scans, surgery, chemo, bone marrow biopsy and more blood tests, infusions and needle sticks than I could count and I tried, losing count at around 125. I came down with COVID pneumonia and was in the hospital for a week, on oxygen for a month while at home. I've had other issues, torn rotator cuff and subsequent physical therapy. All that and my only expenses were doctor copays of $15 and $30 per visit with PCP $15:and specialists $30 and prescriptions as low as $4 and as high as $30. The bills totalled in the 100's of thousands and I never reached the annual out of pocket max to test that part of the plans benefit.
I've never been denied anything and the only delays were due to office staff incompetence where calling the patient advocate number on the back of the insurance card got it resolved within the hour.
As others have said, the same plan from the GM down retire under this plan and they aren't going to screw themselves. My plan is through Dignity Health locally and my doctors were all able to carry me from my pre 65 plan into this Advantage plan seamlessly. I never noticed a thing other than the word Advantage PPO on the insurance card I carry. The one limitation was for hearing aids. Pre Advantage PPO , coverage was $3000 per ear, now at $500. I knew that going in, so got my free hearing aids before turning 65.
Also, as a PPO you can self refer to any specialist or PCP in or out of plan with no extra costs. Any doctor. If I wanted an oncology team outside of the plan, it would be just as covered. I had 2nd opinions of my cancer and treatments with out of plans with no problems.
 
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Skipro33, thanks for that info. As someone also on the plan, it's reassuring to know that you didn't encounter denials or catch-22 fine print limitations to expensive coverages.
 
My husband and I have it through his retirement company and we haven’t paid a cent in the past 3yrs, except for low rx costs. I have several medical issues and it costs nothing to be treated.
 
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