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Beware of medical provider changes in Medicare PPO plans

VacationForever

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My husband had Kaiser forever and continued with Kaiser Medicare Advantage plan when he turned 65. It was a no brainer as we were both used to the system.

We moved out of state and for the first year, 2017, he selected a United Health Medicare Advantage HMO plan because our close friends had it and they said it worked well for them. He tried out for a year and it just did not work for him - saw his PCP only once and all subsequent visits were with a PA who was not very good. He had no issues with the specialist selection.

We researched and he moved to Aetna Medicare Select PPO in 2018. Prior to the switch we checked their system and all his specialists were in their PPO network. Everything worked well until... December 2018. All of a sudden there is not a single orthopedist in our geographical area. There is one 78 miles away and the rest in the next state over, 4 hours away. What!? We checked our other specialists and 2/3rd of them are no longer in their system. Like orthopedist, several other specialist areas had zero provider. In disbelief, he called to speak to an Aetna agent and they confirmed that there are no specialists in many areas of specialization. They said we could use out of network providers and pay 40% of the share of cost. Wait a minute, if he is with traditional Medicare, his share of cost is only 20%.

Thanks to @simpsontruckdriver whom I consulted with there is a special enrollment change period of Jan to Mar where my husband is allowed to make one plan change. The other PPO plan in our area is sold by Humana. We checked the doctor network and it was very good. Simpsontruckdriver is not licensed to sell where we are and this morning a change was made to switch to Humana Medicare PPO in February.

I am now 100% sold on going with a Medigap plan. Aetna literally pulled the rug from under my husband without any notice. While it is legal for them to make changes to their PPO network it certainly was not ethical with the extensive changes that were made. We had gotten 2 of our friends to enroll in the same Aetna Medicare Select PPO plan last year and we just gave them a heads up and that their doctors are no longer in the network. They will be making the same calls to Aetna about their doctor network to confirm our information and then a second call to Humana to make the change.

Buyer beware.
 

WinniWoman

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Interesting that you posted this. Though not Medicare, it is an Aetna retiree or COBRA plan I will be on until Medicare age.

So today I was looking for a doc in the area I am moving to. I got some recommendations from people there. The doc I was going to choose said they took Aetna but I would be out of network and that hardly anyone in NH took it. Also the doc did not take Medicare but if I became a patient the doc would probably take my husband. Wait- what?! I was told by my husband’s employer that it was a national plan and had a network in N.H. Paying the high premium plus the fact that it is a high deductible plan, I need an in network doc!

I call the Aetna “ care coordinator” - they now call them. Not much help. Says she would email me a list, but her email says I have to go online to register on this other website affiliated with my husbands former employer and that then will link me to Aetna to search out providers.

The rep. also tells me that when we had the employer plan we had the “premier” network. Now I would have the POS II network. What?!! I was told the retiree plan is the exact same plan I had when hubby was working!

A lot of offices on the website list were not accepting new patients. Why the heck are they kept on the list then? So I called around more and all of the offices said only the NPs are taking new patients!

Nothing against NPs but I wanted an MD or a DO ( what a concept!) and I wanted someone close by for primary care. I did find a practice with a new internal medicine doc who was accepting new patients but already booked out to April. Called our docs here in NY to send our records to him so they could schedule us- especially my hubby who is on high blood pressure medication

His doc made him come into the office to sign a release, but my doc did not.

( btw- his doc wanted to charge $300 to have the records sent to us. Absolutely crazy!)

So forget about trying to pick a GOOD doc. In the good ol’ USA you are lucky to get ANY doc to see you. Specialists will be even tougher for-us in N.H. and we will probably have to travel far and wide to see one.

It is just unbelievable what is going on in this country with health care. It is getting worse and worse. Paying outrageous money! Having to jump through hoops and deal with nothing but BS. I have a mind to just say forget having insurance and take my chances. Something happens I show up at an emergency room like other people do and pay $5 per month on the bill until I die.

Really pathetic. I am sick of all this health insurance stuff. It really makes me very angry! The system is going to collapse at some point. Hopefully sooner rather than later. God help us.
 
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WinniWoman

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PS Something is going on with Aetna. They also sold their Part D drug plans to WellCare. That is what my husband ( who has a Medigap plan as well) has now for prescriptions. Lord knows what he will have when we move.
 

VacationForever

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CVS bought Aetna last year and I suspect bean counters in CVS are at work here.

As you know many older folks require knee, shoulder or hip replacement or just simple fixes. No orthopedists in the PPO network and we live in a large metropolitan area. No allergists... GI doctors reduced to the 5 worst GI doctors here. My husband did not go the Supplement route because they wanted to charge him tier 2 rate when he tried enrolling for 2017 as he was past the 2 years of non-discrimination period after turning 65. If we did not find the Humana PPO plan - they have 3 PPO plans, we would have gone the Supplement route paying whatever they wanted to charge .
 

Luanne

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If we did not find the Humana PPO plan - they have 3 PPO plans, we would have gone the Supplement route paying whatever they wanted to charge .
Dh and I both went with Medicare supplement plans. We searched for the lowest price for the plan we wanted.

We have had no issues with finding providers.
 

DebBrown

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It's not just retirement and medicare plans. My son has insurance through his employer and when he broke his wrist, there wasn't an orthopedic surgeon without 100 miles in network. Due to a lot of pressure from the employer, the insurance company agreed to pay for the out of network surgeon. We live in the Chicago area and our very spoiled with our healthcare choices but that is certainly not true of much of the country.
 

VacationForever

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It's not just retirement and medicare plans. My son has insurance through his employer and when he broke his wrist, there wasn't an orthopedic surgeon without 100 miles in network. Due to a lot of pressure from the employer, the insurance company agreed to pay for the out of network surgeon. We live in the Chicago area and our very spoiled with our healthcare choices but that is certainly not true of much of the country.
Humana has 75 orthopedists within 15 miles of where we live, Aetna is 0, one is 75 miles away and the rest in the next state over with a 4-hour drive. We are not short on orthopedists. Something is going on with Aetna.

I looked it up... Chicago has 2.7M and we are at 2.2M. We are not small or rural.
 
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WinniWoman

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So now upon further scrutinizing the employer health insurance web site the so called care coordinators told me to go on to search for a provider, I see that the only network that comes up is the Premier network- the one they said was NOT for retiree medical insurance! Another day of endless phone calls, aggravation and waste of my valuable time awaits me. I am about to go insane!
 

bogey21

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PS Something is going on with Aetna. They also sold their Part D drug plans to WellCare. That is what my husband ( who has a Medigap plan as well) has now for prescriptions.

I was just switched from Aetna to WellCare as a result of the sale. As a result my premium went up substantially...

George
 

DancingWaters

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My 90 year old mom was switched from Aetna to WellCare also. Her premium went up $13. That’s a lot for someone living on $13,000. Such disregard to the elderly. She doesn’t qualify for any help because she owns her condo.
 

VacationForever

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So now upon further scrutinizing the employer health insurance web site the so called care coordinators told me to go on to search for a provider, I see that the only network that comes up is the Premier network- the one they said was NOT for retiree medical insurance! Another day of endless phone calls, aggravation and waste of my valuable time awaits me. I am about to go insane!
Can you look at the ACA and private individual market there are more choices? Since you moved, you can enroll within something like 30-60 days of the move. Just make sure you only change your Driver License to NH when you get your ducks lined up with health care first. Then when you find the right plan, get legal residence in NH and then apply for the health insurance plan. Same thing with your husband's Medicare plan, time it well.
 

Quiet Pine

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I also was switched from Aetna to WellCare. My monthly premium went up 40 c, $12.70 to $13.10.
 

WinniWoman

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Can you look at the ACA and private individual market there are more choices? Since you moved, you can enroll within something like 30-60 days of the move. Just make sure you only change your Driver License to NH when you get your ducks lined up with health care first. Then when you find the right plan, get legal residence in NH and then apply for the health insurance plan. Same thing with your husband's Medicare plan, time it well.

Didn't move yet. Not until February. I called one of the aca plans and they didn't say anything about needing the drivers license or residency right away- just have to be moved. Same with the Medigap plan. No one said anything about the drivers license or residency. Husband's part D plan has to change right away. I will have to ask about it. I am so sick of this Sh&^%$t!

I feel like this is all I do.
 

VacationForever

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Didn't move yet. Not until February. I called one of the aca plans and they didn't say anything about needing the drivers license or residency right away- just have to be moved. Same with the Medigap plan. No one said anything about the drivers license or residency. Husband's part D plan has to change right away. I will have to ask about it. I am so sick of this Sh&^%$t!

I feel like this is all I do.
Right now medical enrollment/insurance plan is still sold at state level. You will need to change residency, and driver license is the standard way to legalize residency, to buy local medical insurance.
 

Passepartout

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Might have been my fault for not looking at the formulary, but my meds went up in price on 1/1/20 My already expensive Xarelto was $115 a month, jumped to $195 co-pay. I didn't change insurance carriers or plans because I'd been happy (enough) to not change. Shame on me.
 

WinniWoman

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Right now medical enrollment/insurance plan is still sold at state level. You will need to change residency, and driver license is the standard way to legalize residency, to buy local medical insurance.


I called the insurance company back and they said not necessary, though they might ask to see some kind of document that shows we live where we do, like our house closing statement. We do, of course, intend to get our driver's licenses asap and register our cars and to vote. In NH this involves going to three different places! SMH.....
 

Luanne

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Right now medical enrollment/insurance plan is still sold at state level. You will need to change residency, and driver license is the standard way to legalize residency, to buy local medical insurance.
When we moved I was still working and was covered by the medical coverage through my work. Dh was covered by them as well. We moved from California to New Mexico and I don't remember what impact, if any, there was on who the insurance was through. I don't remember having to provide any proof of residency. I retired soon after moving (dh was retired as well) and was still covered through my former employer until I reached Medicare age. Again, I don't think the provider changed until that time.
 

Talent312

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I was just switched from Aetna to WellCare as a result of the sale.
As a result my [Part D] premium went up substantially.

The switch would'a increased DW's Part D premium significantly, as well(care).
But during open enrollment, she chose WellCare Wellness instead of Select.
The new plan listed our pharmacy as "preferred" and her premium went down.

Still, there was a hiccup in getting the lower-priced plan:
WellCare was confused. They tried to set up both Select and Wellness plans.
She got ID's+mail mail for both. SS sent a statement w-the higher deduction.
We called Wellcare. They deleted Select. A few days later, SS online got it right.
<sigh>
.
 
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VacationForever

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When we moved I was still working and was covered by the medical coverage through my work. Dh was covered by them as well. We moved from California to New Mexico and I don't remember what impact, if any, there was on who the insurance was through. I don't remember having to provide any proof of residency. I retired soon after moving (dh was retired as well) and was still covered through my former employer until I reached Medicare age. Again, I don't think the provider changed until that time.
What I am saying is that you want medical insurance in the new state, you need to buy there. We were in California, changed legal residency in Sept 2016 but we kept our Kaiser insurance until end of the year, knowing that we could only go back to CA to use medical services. The following year we applied for new medical insurance.
 

Luanne

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What I am saying is that you want medical insurance in the new state, you need to buy there. We were in California, changed legal residency in Sept 2016 but we kept our Kaiser insurance until end of the year, knowing that we could only go back to CA to use medical services. The following year we applied for new medical insurance.
I'm still not quite understanding.

When we moved I didn't buy new insurance in New Mexico. I kept whatever plan I had when I lived in California and was insured through my employer. Maybe because it was a big company with locations all over the country they were able to provide medical coverage, and they made some kind of change. I honestly don't remember who the coverage was through, it may have been United Healthcare.
 

VacationForever

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I'm still not quite understanding.

When we moved I didn't buy new insurance in New Mexico. I kept whatever plan I had when I lived in California and was insured through my employer. Maybe because it was a big company with locations all over the country they were able to provide medical coverage, and they made some kind of change. I honestly don't remember who the coverage was through, it may have been United Healthcare.
We never had a plan that was covered out of state, so yours was different from ours.
 

bogey21

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We never had a plan that was covered out of state, so yours was different from ours.

One of the advantages of traditional Medicare, plus Supplement, plus Plan D is that where you live and where you access Health Care doesn't matter. I guess you have to be in the US though. Of course the downside is the higher cost for all this vs Advantage Plans...

George
 

VacationForever

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One of the advantages of traditional Medicare, plus Supplement, plus Plan D is that where you live and where you access Health Care doesn't matter. I guess you have to be in the US though. Of course the downside is the higher cost for all this vs Advantage Plans...

George
Not necessarily that Supplement is more expensive. My husband's Humana costs $150 per month, not counting the Medicare standard premiums plus applicable IRMAA. In my husband's case Supplement is more expensive because he is bumped to tier 2 rates but for most individuals who apply at 65-67 or without prior medical conditions deemed higher risk, the cost can be a wash between Supplement and an Advantage plan.
 
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bogey21

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The total cost of my standard Medicare, plus Part B, plus a Supplement, plus a Plan D, plus two IRMMAs is about $5 thousand a year. I'm sure I could get it for less if I spent more time looking for alternatives but alas I spend my time on other things...

George
 

Luanne

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The total cost of my standard Medicare, plus Part B, plus a Supplement, plus a Plan D, plus two IRMMAs is about $5 thousand a year. I'm sure I could get it for less if I spent more time looking for alternatives but alas I spend my time on other things...

George
Mine is $4200/year, dh is closer to $5000. That is for standard Medicare, a supplement and a Plan D. What is an IRMMA?
 
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