Medicare Advantage Plans that allow you to visit any doctor?

[chriskre]

Does anyone know of any Medicare Advantage Plans that allow you to visit any doctor?
I guess that would be out of network coverage, I'm assuming?

I've had my PCP for 15 years and he doesn't take any Advantage Plans but I don't want to lose him because I have a few rare diseases
and starting over with another PCP would be a nightmare but my Medigap is $900 a month so I'm definitely looking for options at this
point because I can't switch Medigaps until I'm 65. I'm 60 now so 5 years to go.

I have been holding off going on an Advantage Plan because with the coinsurance on my meds it was a wash but now it seems that
the MA plans even with the copays may be coming out ahead for at least the next 5 years except for losing my PCP which I definitely
don't want to do. I could pay him Out of pocket but would much prefer a plan that would pay him something.
The Advantage Plan world is so overwhelming. I helped my Mom with it but she's dual enrolled so it was easier.
Thanks.

 

[linsj]

I have a Humana Choice PPO Advantage plan (w/ $0 monthly fee) that lets me visit any doctor. Depending on the type of doctor or procedure, the copay is the same out of network as in. As long as you avoid HMO plans, I think other companies have the same provision.

 

[dagger1]

We have United Healthcare Advantage PPO.

 

[simpsontruckdriver]

As a former Medicare agent in FL/NC/VA/CA, you should talk to an independent agent about a PPO. You may have to pay more for your PCP (not much), but at least you can choose your providers. In-network providers are cheaper, so you could keep your doctor, but choose in-network providers for everything else. He (and I when I did it) has access to calculators which point to the cheapest plans out there in your case.

TS

 

[chriskre]

I have a Humana Choice PPO Advantage plan (w/ $0 monthly fee) that lets me visit any doctor. Depending on the type of doctor or procedure, the copay is the same out of network as in. As long as you avoid HMO plans, I think other companies have the same provision.

Thanks.

 

[chriskre]

We have United Healthcare Advantage PPO.

This is where I started my search calling AARP but they said they don't have any plans with AARP and to call the regular UHC line. Good thing I'm starting this search now but there are so many companies in my city that wow.

 

[chriskre]

As a former Medicare agent in FL/NC/VA/CA, you should talk to an independent agent about a PPO. You may have to pay more for your PCP (not much), but at least you can choose your providers. In-network providers are cheaper, so you could keep your doctor, but choose in-network providers for everything else. He (and I when I did it) has access to calculators which point to the cheapest plans out there in your case.

TS

Yeah I'm starting to think this is the way to go with this.
I have an appointment with one of the online companies and a local agent so will see what they come up with.
I don't mind paying for my PCP if I have to but I don't want there to be issues with him ordering something and then they don't want to authorize it because he's not recognized as my PCP because I need to have one of their official PCP's so I will end up with two PCPs.

 

[Timeshare Von]

My limited experience (less than 2 years) on Medicare has shown that each state is really different in what their advantage plans cover/accept. I'm really happy with the one I have here in Wisconsin which is seemingly unique as when I start thinking about when we move/leave here, what will be my options. I don't see anything close to what I have, especially in terms of being away from home and being able to see any doctor/facility that accepts Medicare and it being covered as "in network" even though I'm out of state, etc.

 

[chriskre]

My limited experience (less than 2 years) on Medicare has shown that each state is really different in what their advantage plans cover/accept. I'm really happy with the one I have here in Wisconsin which is seemingly unique as when I start thinking about when we move/leave here, what will be my options. I don't see anything close to what I have, especially in terms of being away from home and being able to see any doctor/facility that accepts Medicare and it being covered as "in network" even though I'm out of state, etc.

I'm in Florida and we have soooooo many options it's dizzying.
Especially in my County in Miami.
These companies are tripping over themselves to recruit you with $250 cash cards and all sorts of freebies.
Free meals, buses to the gym and appointments, zero copays for anything, zero meds, zero out of pocket limits
and on and on. Mom pays for nothing ever not even her Medicare premium.

 

[Sandy VDH]

But I suspect that a lot of Advantage plans will offer a lot less next year, now that they have to notify you that you are not using benefits that you have available to you. It is driving up their costs, which means they either raise rates or offer less. Most are expected to just offer less.

 

[DrQ]

A PPO plan is the option that you want to explore. Look at the coverage for "Out of Network" and then look at the company for complaints of treatment rejection because of pre-authorization.

If you are on a Medicare Supplement Plan now and you change to an Advantage plan before you are 65, does that lock you in when you turn 65?

 

[rapmarks]

My advantage plan offers coverage st same date for out of network providers. But a warning, they refused to allow another petscan which oncologist ordered

 

[chriskre]

A PPO plan is the option that you want to explore. Look at the coverage for "Out of Network" and then look at the company for complaints of treatment rejection because of pre-authorization.

If you are on a Medicare Supplement Plan now and you change to an Advantage plan before you are 65, does that lock you in when you turn 65?

No. At 65 I can apply as if I don't have any pre-existing conditions at 65 but right now because I am on disability I can be discriminated against which is why my premiums are so high. Florida isn't one of the states that has guaranteed issues for everyone.

 

[chriskre]

But I suspect that a lot of Advantage plans will offer a lot less next year, now that they have to notify you that you are not using benefits that you have available to you. It is driving up their costs, which means they either raise rates or offer less. Most are expected to just offer less.

I bet. They've made it very difficult to use many of these benefits too.
If not for me my Mom would have not been able to figure out how to redeem most of her benefits.
She doesn't drive anymore, uses a wheelchair now, has no smartphone and doesn't use the internet
so the gift card is useless to her so I have to shop for her. I imagine there are lots of Seniors who live
alone who have no one to help with using their cards. Plus the OTC card is also difficult to use as it is.
CVS makes it difficult to know what products are included in the OTC when you shop in store.
And the prices are different than what is on the shelf, they are inflated so you never get the benefit of the sales prices.
It's ridiculous. $6 for a tube of Colgate Toothpaste. $6 For a package of 30 Wipes. Both can be
bought at the Dollar Tree for $1.25.

 

[chriskre]

My advantage plan offers coverage st same date for out of network providers. But a warning, they refused to allow another petscan which oncologist ordered

I am thinking to buy a Cancer Insurance Plan along with this just for this reason.
I've seen some videos about this that they pay you a lump sum on diagnosis to pay for things that the insurance
doesn't or won't pay for and they seem reasonable at about $20 a month.
Not sure if they will sell me one since I had melanoma a few years back but will try to buy one.

 

[stmartinfan]

My limited experience (less than 2 years) on Medicare has shown that each state is really different in what their advantage plans cover/accept.

I agree. Plans vary widely based on where you live and change year to year. Right now in our area one of the major medical groups, which happens to be where most of my doctors are, has stated they will refuse to accept a couple of the big insurers next year because they have pushed their reimbursement rates too low. And I think it’s Humana that has pulled out of our area completely.

My husband spends hours each year comparing the various plans and confirming that our different doctors are included—which can be challenging to do sometimes. We've changed plans several times as a result to get the plan that's cheapest but provides the level of care we want. If you don't want to do this yourself, the broker seems like the way to go.

 

[chriskre]

I agree. Plans vary widely based on where you live and change year to year. Right now in our area one of the major medical groups, which happens to be where most of my doctors are, has stated they will refuse to accept a couple of the big insurers next year because they have pushed their reimbursement rates too low. And I think it’s Humana that has pulled out of our area completely.

My husband spends hours each year comparing the various plans and confirming that our different doctors are included—which can be challenging to do sometimes. We've changed plans several times as a result to get the plan that's cheapest but provides the level of care we want. If you don't want to do this yourself, the broker seems like the way to go.

I definitely don't want to be doing this every year.
I have to do this for the next 5 years and then I will switch back to Traditional Medicare cause
by then I can qualify for the group rates but then who knows what they will be but I'm hoping
they won't be $900 a month. Right now they are around $250 plus the drug plan. I would
welcome that in a heartbeat.

 

[simpsontruckdriver]

I am thinking to buy a Cancer Insurance Plan along with this just for this reason.
I've seen some videos about this that they pay you a lump sum on diagnosis to pay for things that the insurance
doesn't or won't pay for and they seem reasonable at about $20 a month.
Not sure if they will sell me one since I had melanoma a few years back but will try to buy one.

Shop around. Some may say no, some may say the diagnosis and remission must be x years ago. The best number to reach for is your Maximum Out-Of-Pocket. Let's say your MOOP is $16000. Cancer treatments regularly hit that amount, so essentially, it paid your copays. If you think you'll be out of work for a month, add your monthly Net Pay to that amount. Once you make a claim, most likely the plan ends.

TS

 

[rapmarks]

I am thinking to buy a Cancer Insurance Plan along with this just for this reason.
I've seen some videos about this that they pay you a lump sum on diagnosis to pay for things that the insurance
doesn't or won't pay for and they seem reasonable at about $20 a month.
Not sure if they will sell me one since I had melanoma a few years back but will try to buy one.

I would have hit the jackpot with that policy

 

[chriskre]

Shop around. Some may say no, some may say the diagnosis and remission must be x years ago. The best number to reach for is your Maximum Out-Of-Pocket. Let's say your MOOP is $16000. Cancer treatments regularly hit that amount, so essentially, it paid your copays. If you think you'll be out of work for a month, add your monthly Net Pay to that amount. Once you make a claim, most likely the plan ends.

TS

Thanks.

 

[chriskre]

I would have hit the jackpot with that policy

Definitely don't want to hit this jackpot.

 

[Timeshare Von]

I am thinking to buy a Cancer Insurance Plan along with this just for this reason.
I've seen some videos about this that they pay you a lump sum on diagnosis to pay for things that the insurance
doesn't or won't pay for and they seem reasonable at about $20 a month.
Not sure if they will sell me one since I had melanoma a few years back but will try to buy one.

I have a friend who used to sell Mutual of Omaha. They had such a policy (for cancer and/or heart related like heart attack or bypass). Unfortunately, the underwriting at that time (the mid 2000's) was very tight, and being obese (BMI 30%+) they wouldn't write the policy. About 10 years later, I was Dx with ovarian cancer.

 

[chriskre]

So I spoke to an independent Broker and it's not a good situation for me unfortunately.
I would save on doctors but the Meds would be $30K .
I may be stuck for 5 years. Ugggh.

 

[rapmarks]

So I spoke to an independent Broker and it's not a good situation for me unfortunately.
I would save on doctors but the Meds would be $30K .
I may be stuck for 5 years. Ugggh.

What happens in five years?
is the 30000 the cost of the insurance or the copays for meds. It is supposed to be capped at 2000 out of pocket starting in 2025.

 

[chriskre]

What happens in five years?
is the 30000 the cost of the insurance or the copays for meds. It is supposed to be capped at 2000 out of pocket starting in 2025.

Apparently that would be my max out of pocket for all my meds.
I have 3 that are only available in brand name and are more than $1K a month each.
Apparently they are not included in the max out of pocket fees.

He said I'm going to have a problem when I turn 65 even staying on a Medigap with a drug plan covering all my meds.
He actually said to just stay on my group plan because that's actually the cheapest option for me which is why I've kept if all these years but it's been so expensive I was hoping for some relief but I guess not.
I've basically used all my 401K money for paying for health insurance.
I won't have anything left when i'm 65. Sigh.