Medical Insurance

[bogey21]

I had a Medicare Advantage Plan for about 3 months primarily because of its low cost. But after thinking about it I switched back to Regular Medicare plus a Supplement plus a Medicare Prescription Drug Plan. Why? Simply because if something serious happens to me I want to be able to go to a Center of Excellence for whatever hits me and not be locked into a Network. But understand that the cost of what I did is not insignificant...

George

 

[rapmarks]

Rap marks
I went back and read your posts about your cost and procedures they paid for. Your monthly premium is higher than what I was quoted. I only got 23 years in teaching. I have friends in the same plan and they think it’s wonderful, but they also had full retirement and were born with silver spoons in their mouths. I guess I can gain good info from them but my income is not what theirs is. Will they cover you when you travel, how about to Mexico etc?

I do not know if we are covered out of the country, but I doubt it.
Are you retiring as a teacher from Illinois? I know that other state employees from Illinois had a different, more comprehensive plan than the teachers. Also, the cost differs if you live in Illinois, which we no longer do. We moved out 16 years ago, and our cost was cut in half when we left the state, but it was all pre Medicare. I am not sure if the cost varies like this any longer. I did not have the full 35 years either. Also when they switched us out of the Medicare supplement plan to the Medicare advantage, they neglected to mention that we now had to pay an extra charge to Medicare for having part D, a surcharge

I know when I posted my yearly charge, I posted that my out of pocket was $1800, but the policy says it is supposed to be max $1000. I asked a few times about the discrepancy, but was never able to get a satisfactory explanation

 

[isisdave]

I think the big distinction is not between Advantage and Supplemental, but between HMO and PPO. So this is not really a Medicare only question.

With HMO, you're covered with their providers, but need special permission to go to other doctors. This may take you months to get, and if you don't live in a big metro area, there may be only one specialist, he or she may have a long waiting list, and when you get there, might not be so competent. Also consider the distance to their contracted hospital, if you're likely to be admitted to one. Kaiser is big in our town, but their nearest hospital, and many of their specialists, are 25 miles away, and there is no good public transport.

With a PPO, you can see a much larger groups of doctors without waiting, although some may have a smaller copay for you than others.

DW was a mental health provider; she had a couple of HMO patients who died because it took them 3 months to get their specialist visit and diagnose (for example) liver cancer.

Depending on where you live, there may be Advantage PPO plans although most are HMO. In my county in SoCal, I have a choice of 32 HMOs and ONE PPO. I've seen other areas that have several, though.

 

[VacationForever]

I think the big distinction is not between Advantage and Supplemental, but between HMO and PPO. So this is not really a Medicare only question.

With HMO, you're covered with their providers, but need special permission to go to other doctors. This may take you months to get, and if you don't live in a big metro area, there may be only one specialist, he or she may have a long waiting list, and when you get there, might not be so competent. Also consider the distance to their contracted hospital, if you're likely to be admitted to one. Kaiser is big in our town, but their nearest hospital, and many of their specialists, are 25 miles away, and there is no good public transport.

With a PPO, you can see a much larger groups of doctors without waiting, although some may have a smaller copay for you than others.

DW was a mental health provider; she had a couple of HMO patients who died because it took them 3 months to get their specialist visit and diagnose (for example) liver cancer.

Depending on where you live, there may be Advantage PPO plans although most are HMO. In my county in SoCal, I have a choice of 32 HMOs and ONE PPO. I've seen other areas that have several, though.

You have said it! Ding Ding Ding Ding Ding! LOL. My husband has the Medicare Advantage PPO and it is very flexible. It also covers out of state and worldwide travel. We have not tested it and we also have travel insurance through GeoBlue for outside of US coverage.

 

[rapmarks]

I went on an hmo for about nine months, it was horrible. I started having stomach pain while on a long trip, not sufficient to qualify as an emergency. By the time I got home, I rushed in to see the only doctor on the hmo list. I was referred to a specialist who did an endoscopy and I had h.pylori. He would not give me the medication until he tested my husband. The primary physician would not give my husband the referral to see the specialist. After over a month, I was given the medication, two antibiotics and a drug which was like omrazopol. I went to get a refill and the pharmacist told me that I had used up my lifetime allowance, I was limited to thirty days supply lifetime. As soon as the time was up and I could switch, I got out of the plan and paid double rather than to go through that again. I was able to go back to my old doctor again.

 

[geekette]

I went on an hmo for about nine months, it was horrible. I started having stomach pain while on a long trip, not sufficient to qualify as an emergency. By the time I got home, I rushed in to see the only doctor on the hmo list. I was referred to a specialist who did an endoscopy and I had h.pylori. He would not give me the medication until he tested my husband. The primary physician would not give my husband the referral to see the specialist. After over a month, I was given the medication, two antibiotics and a drug which was like omrazopol. I went to get a refill and the pharmacist told me that I had used up my lifetime allowance, I was limited to thirty days supply lifetime. As soon as the time was up and I could switch, I got out of the plan and paid double rather than to go through that again. I was able to go back to my old doctor again.

omg, that is horrendous!

I had an HMO once when I was very young and healthy, and would never ever do an HMO again.

And since then, I have gone for whatever treatment I need when I need it from whichever provider I deem best and deal with the money part later. I will not ever let insurance company dictate my treatment with full understanding that I may be stuck with full cost. Saw my radiation oncologist in uninsured-December. Cost me $140, much much much less than the cost of COBRA for that month would have been.

 

[DancingWaters]

I retired in Ohio. I’m actually vacationing in Florida now, and my 3 friends are retired teachers from Ohio. They are most of the time pleased with their insurance and have had many health issues since they retired. I will have 3 choices of coverage and I decided to choose the Aetna PPO one. I hope I don’t blow this big decision

 

[clifffaith]

On Saturday I reached into the coat closet to pull a suitcase out that had our toiletries in it. By now I forget what I was looking for. Suitcase was at the back, behind our timeshare car travel box. So I had to reach back and lift up to clear the box. Took two steps and about dropped to my knees in pain. I have never in the six years I've been treated for a bulging disc and spinal stenosis experienced so much pain. I'm talking sitting in a chair and crying pain while cats and Cliff are trying to console me. On Monday I went for my first chiro appt since the back and leg pain started in 2013. Cut the pain in about half, although within 24 hrs I'm in agony again. Cliff asked "on a scale of 1-10..." Had to tell him that scale is out the window, I'm talking a 30 now. The good news is it turns out my insurance actually pays for 24 chiro visits. I assume they always have, it's just that when I started with the rheumatologist, and then three years ago with the pain specialist, I hadn't even thought about the chiro. So glad he is able to give me some relief, and it's paid for too. I don't know why doctors and chiropractors can't work together. Back 25 years ago when I still had migraines a trip to the chiro would loosen up my neck and shoulder muscles to allow the prescription migraine medicine to work. My Chinese pain Doctor thinks chiro and acupuncture are a bunch of hooey.

 

[am1]

Why do people accept this treatment?

 

[VacationForever]

My Chinese pain Doctor thinks chiro and acupuncture are a bunch of hooey.

Chiro is dangerous. Acupuncture can provide temporary pain relief. I won't do either one.

 

[WinniWoman]

I worked for a chiropractor and the whole basis for their practice is to have you keep coming back.

We were required as employees to have adjustments every week and I hated having to because I had no real back or any health issues (except a herniated disc from years before that was not giving me any trouble).

Sometimes I wonder if he did more harm than good for me. But- others swear on the treatment,

 

[Patri]

I worked for a chiropractor and the whole basis for their practice is to have you keep coming back.

Not true for everyone. My dad was a chiropractor, and ethical. He served our community well, and was highly respected. When I needed a chiro years ago for pain, one visit to a local guy took care of 95% of it.
I have heard the same complaint regarding physical therapists. They say you need treatment, but as soon as the insurance ends, BINGO, that's all we can do for you, you don't need to come back any more. I will say, there is a segment of medical practitioners who do operate on that philosophy, to encourage patients to come back when not needed. It is sad. Two years ago I was sent to a PT for a shoulder injury. Went twice, I believe, and realized the exercises were lame and I could do them at home easily. Even though insurance would have covered several more visits, I stopped going, and got well.

 

[rapmarks]

Chiro is dangerous. Acupuncture can provide temporary pain relief. I won't do either one.

Orthopedic doctor said “won’t hurt, won’t help”

 

[bogey21]

I worked for a chiropractor and the whole basis for their practice is to have you keep coming back.

Dentists are the same. At least my new one is. They used to recommend cleaning once a year, then it was twice a year and now it is four times a year. And when they are finished with a cleaning and you are not ever out of the chair they are scheduling your next appointment. Wasn't it Nancy Reagan who said "Just Say No"...

George

 

[WinniWoman]

Not true for everyone. My dad was a chiropractor, and ethical. He served our community well, and was highly respected. When I needed a chiro years ago for pain, one visit to a local guy took care of 95% of it.
I have heard the same complaint regarding physical therapists. They say you need treatment, but as soon as the insurance ends, BINGO, that's all we can do for you, you don't need to come back any more. I will say, there is a segment of medical practitioners who do operate on that philosophy, to encourage patients to come back when not needed. It is sad. Two years ago I was sent to a PT for a shoulder injury. Went twice, I believe, and realized the exercises were lame and I could do them at home easily. Even though insurance would have covered several more visits, I stopped going, and got well.

Yup. That is what happened to me with PT as well, so as soon as the new year started and my high deductible kicked in, I stopped.

I agree- there are ethical practitioners out there and then there are some that are not, including doctors. It is a shame, but a lot of health care treatment is based on who is paying and when and how much instead of what the patient might actually need or not need.

 

[WinniWoman]

Dentists are the same. At least my new one is. They used to recommend cleaning once a year, then it was twice a year and now it is four times a year. And when they are finished with a cleaning and you are not ever out of the chair they are scheduling your next appointment. Wasn't it Nancy Reagan who said "Just Say No"...

George

Yes- right! My husband and I have different dentists and they both do the same thing as yours!

Same with the eye doctor. Used to be go every two years unless you have an issue. Now they try to get you back every year or even every 6 months.

 

[VacationForever]

Not true for everyone. My dad was a chiropractor, and ethical. He served our community well, and was highly respected. When I needed a chiro years ago for pain, one visit to a local guy took care of 95% of it.
I have heard the same complaint regarding physical therapists. They say you need treatment, but as soon as the insurance ends, BINGO, that's all we can do for you, you don't need to come back any more. I will say, there is a segment of medical practitioners who do operate on that philosophy, to encourage patients to come back when not needed. It is sad. Two years ago I was sent to a PT for a shoulder injury. Went twice, I believe, and realized the exercises were lame and I could do them at home easily. Even though insurance would have covered several more visits, I stopped going, and got well.

... and I feel the same way about PT too. I have had many PT sessions for various issues and NONE worked. Some made my condition worse.

 

[Steve Fatula]

I had a Medicare Advantage Plan for about 3 months primarily because of its low cost. But after thinking about it I switched back to Regular Medicare plus a Supplement plus a Medicare Prescription Drug Plan. Why? Simply because if something serious happens to me I want to be able to go to a Center of Excellence for whatever hits me and not be locked into a Network. But understand that the cost of what I did is not insignificant...

George

My DW must be the only one here who had an Advantage plan that does *not* lock you into a list of doctors, they do exist! At least in our area.

https://www.humana.com/medicare/medicare-advantage-plans/humana-choice-pffs

That being said, we converted to a supplement plan as it's actually cheaper on our area. Much cheaper overall. We took care to find one that actually includes Silver Sneakers.

Regarding the PT and Chiro.... Both have helped me a lot during my life. I had horrible stops you in your place low back pain for many years, doctors could do nothing except drug me which I refused as those do not work for me. Chiro got me out of the pain, still don't have it. PT has helped me immensely as well, the latest was after rotator cuff surgery. People who do not do the work after such surgery are almost doomed to a life of pain. It also helped with with another issue that was not surgery related. So, they both can work, but clearly people have had different experiences.

 

[bluehende]

I worked for a chiropractor and the whole basis for their practice is to have you keep coming back.

We were required as employees to have adjustments every week and I hated having to because I had no real back or any health issues (except a herniated disc from years before that was not giving me any trouble).

Sometimes I wonder if he did more harm than good for me. But- others swear on the treatment,

I wonder about the legality of requiring you to go through what is basically a medical procedure.

 

[WinniWoman]

I wonder about the legality of requiring you to go through what is basically a medical procedure.

Right. I always thought about that as well. But- I wanted to keep the job and not make waves about it. His other 2 employees were so nice and they loved him. I never liked him. LOL!

 

[Brett]

Yes- right! My husband and I have different dentists and they both do the same thing as yours!

Same with the eye doctor. Used to be go every two years unless you have an issue. Now they try to get you back every year or even every 6 months.

absolutely true. My mother was going to a dermatologist every few months for years, the waiting room was filled with older medicare patients.
The dermatologist finally retired (at 40 !)

 

[Steve Fatula]

Yep, I see this as well, nothing but a ploy to make money imho. Of course, one can politely decline.

 

[clifffaith]

We liked our periodontist, but she was always (meaning every two years) wanting to "slice and dice" our gums. 18 months ago they caught me on a bad day when Cliff was standing at the receptionist's desk and they wanted me to check his schedule for another couple of quadrants (at $1600 each). I think I had bills in front of me and just said "no way, not now". We had been alternating between dentist and perio for cleanings 4 times a year, now we use the dentist for all of the cleanings figuring she'll send us back to the perio if she sees fit. And I can tell you after having a back molar pulled last week, that I'd rather have another tooth pulled than have gum surgery again!

 

[isisdave]

I'm one of those Medicare seniors in the dermatologist's waiting room every four months or so.

I've hated my skin since I was 12. It required annual work at age 30, semi-annual at 50, and now I schedule at four month intervals, and there is always work to be done. I don't care if the doctor names his boat after me; I've had about six basal cell carcinomas removed (most when still small), and keeping the nasty AKs from developing further is just a necessity of life. FORTUNATELY, all the trouble seems to be on the outside, and the harder-to-get-to stuff is all OK. And thinking about what I'd look like if I'd been born 100 years earlier makes me quite grateful.

So it's a count-your-blessings thing.

 

[DancingWaters]

Thanks for all the information on health insurance for someone turning 65 years old. I went to a meeting last night hosted by Teachers retirement. Is was very informative and lots of people asked questions. I’ve made my decision that I will go with Teachers retirement insurance in June and hope for the best. It will cost me $200 @ month and then $135.50 a month for part B Medicare. I found out also that there are 3 ways to qualify for Medicare part A and I have 2 out of the 3. Whew! I feeling better about the whole process. Thanks tuggeds.....listening ears are great to sort things out.