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Medicare Annual Enrollment Period coming up!

Steve Fatula

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Doesn't the monthly cost for a Medicare Advantage plan depend on a few things. Like where you live, who the carrier is, what the plan is? We opted for Supplemental Plans rather than Medicare Advantage. We felt it would give us more flexibility.

It can greatly depend on where you live. In some states, people complain they are limited to what doctors they can use. Here in Oklahoma, my wife had a plan which allowed her to use any doctor via an advantage plan (PFFS). In Ohio where my sister lives, most Advantage plans cost $0 extra. Here, none did (at the time), they all cost extra.
 

Luanne

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Supplements do give a lot of flexibility but with higher premiums. In most areas, you can get a PPO (Preferred Provider Organization) that allows you to choose your doctors, but ones that do not take your MAPD are slightly higher copays.

In another post, I gave a major reason to sign up for an MAPD from either Humana or United Healthcare: $0 copays for primary care doctors, mental health, and telemedicine for the rest of 2020. Supplements' copays are unchanged. Blue Cross Blue Shield is waiving copays only for telemedicine for 2020. Aetna is only waiving for Coronavirus diagnosis.

TS
So where did the $144/month come from?

My monthly premium for a supplement is less than that.
 

topmom101

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I AM bleary eyed and completely overwhelmed. I have read so much material and spent hours and hours watching you-tube videos. I turn 65 in June and just signed up for an AARP Medicare Advantage plan #1. It all sounded so good on the phone but now I am having doubts. I live in South Carolina. My husband works for Lowe’s and both of us are covered under their health plan. I need to make decisions, but, frankly, I am so confused.

What are your thoughts on the advantage plans? One of the things that is bothering me and the insurance broker did not tell me is that I will not be covered out of state unless it’s an emergency. My daughter lives in NY and I visit her one week every month. What would happen is I were to get sick or take a fall?

Also, as I mentioned above, I signed up over the phone for this plan (the only one he told me about) 2 days ago with a broker from United Healthcare. Am I locked into it or can I still cancel? The plan would be effective as of June 1st.

I welcome your advice.
 
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As a former agent for AARP/United Healthcare (I would need to be re-appointed), I am familiar with those plans. The way most Medicare Advantage plans work is yes, you're only covered for ER/Hospital stays out of state or dialysis. But, there is one feature the salesman did not mention: travel. If you need non-emergency care in another area (let's say you get a throat infection, so urgent care is better than ER), you can call UHC and they can point you to an in-network provider and switch your network to that area. This is a PDF about the plan. You can call UHC customer service and find out if your plan is eligible. And this applies to *****ALL***** AARP/UnitedHealthCare Medicare Advantage with Prescription Drug subscribers, call UHC to see if your plan has that benefit. Humana also allows the same, switch to the new area by calling customer service.

If your plan does not, you MAY be able to switch to one that does by calling customer service. If not, you would have to wait until Annual Enrollment Period (AEP). Usually, when you first sign up, you're stuck with that plan until you switch during AEP, but customer service may be able to find a way (no guarantees).

TS
 

dago

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From what I have read from other people, always check your Part D plan coverage- even if it is the same plan because suddenly you could be paying a lot more next year for the drugs you are on. So don't automatically renew before you check this out.

I have also read some things about Humana renewing people into another plan and also trying to coerce people into Medicare Advantage plans. Be aware.
Exactly - I have Humana Part D. Just before open enrollment they notified me that my plan was changed and my premium about tripled. I started looking around for other options and found that I could get the same coverage from Humana for even less than I paid last year. The only difference was some of the RX I need moved to a different tier. All things being equal, my out of pocket costs was still way less than the plan they were going to put me in. I told a friend of mine who had the same plan that I had in 2019 to be aware of what was going on. He ended up waiting too long to take any action and it was beyond the open enrollment date, so he couldn't change. However, when he talked to Humana in person, the Rep did try to coerce him into Medicare Advantage plans.
 

dago

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Regarding Part-D... if you're not going to take an MAPD (either not taking Part-B or you're taking a MediGap plan), and you're healthy, talk to an agent to get the least expensive PDP. Why pay $30+/month when you can get one as low as $15/month?

TS
That's what I did. Premium is $13.20
 

pittle

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We are"grandfathered" in for UHC Plan F, so do not worry about the $144 Part B and plan to keep it for as long as it is available to us. We do not take any prescription meds, so we have the $13.30 Humana Walmart Plan D for each of us.
 

topmom101

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TS, you saved the day!!! Your advice was exactly what I needed to hear. I called UHC and confirmed that my plan does indeed qualify for the Passport benefit. That solves my problem of being uninsured while visiting my daughter in NY. Funny, though.... before seeing your reply earlier today, I had called UHC to confirm something else and spoke to a different agent who also failed to mention this benefit. After reading your reply, I called a third time and spoke to a woman who confirmed the Passport benefit and explained it thoroughly. I am in excellent health and have decided to stay with the advantage plan. TS, I can’t thank you enough.
 

dago

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I cannot remember where I read it. I have been reading so much about this these past few days I am going loony.
You are correct you can downgrade(F to G). You basically cannot upgrade, but you may be able to, but you would be subject to the previous conditions situation.
I can feel your frustration and anger. Getting medicare insurance is overwhelming. I remember when I was 65(10 years ago) and was going through the process. Felt just like you. It should not be that complicated, IMO.
 
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For those who feel they're overwhelmed with Medicare, get an agent. I am more than willing, but you can find someone who lives in your area. We're not here to make money off of your Medicare, we're here for you to "pick our brains". Commissions (paid by Medicare) are a bonus.

Todd S
Aetna & Humana
Licensed in Florida, North Carolina, and Washington (but eligible in most other states).
 

dago

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My husband's health is good right now thankfully. The only difference with G is the Part B deductible $185 outlay, but the premiums are similar. Hey- $185 is $185. I am just not sure what to do because people keep saying that the F premiums are going to rise over time and so forth.

G premium is $210 per month and F is $230. Both Empire. I guess either way- the F you lay out $20 more per month for the premium. With G you lay out up to about $15 per month for the deductible IF you use it.

Then again, I assume the Part B deductible can go up?
Yes Part B deductible can and will increase. Also, my understanding of Plan G is in addition to the Part B deductible one needs to pay one also has co-pays to docs and ER.
 

dago

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I'm not sure about your area (I am in Florida), but for 2020, Humana is rolling out a revised "WalMart" PDP. You can call Humana directly, an agent can get you set up on a less-expensive plan. The whole "WalMart" is just a saying, that it is usually the least expensive plan. *In addition*, you can save more by signing up for the Humana mail-order pharmacy (does not include specialty or narcotics), where 3 month generics are less than $5.00. Humana can point you in the right direction on both.

TS
Exactly - That's the plan I have (I'm in Ohio) The premium is $13.20/month
 

dago

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I wonder how much the supplemental insurance paid that wasn't covered under regular Medicare ? When I bought supplemental insurance for my inlaws it did seem like Medicare actually covered everything. The supplemental we had for my mother in law didn't help with her perscription costs as the drug she was on was new, it didn't help with nursing home stay to recover and it didn't pay for hospice.

For my father in law the supplemental insurance didn't really pay for anything either and he had multiple heart issues that included 7 bypasses in 1 operation that had a 25 day hospitial stay, 90 day nursing home stay and continued care.

These were Humana Plans.

Bill
I could be wrong, but I don't believe Medicare Advantage plans pay for Nursing home stays either. My FIL was in a nursing home for a short period of time before he passed and his MA plan didn't cover the expenses.
 
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Most Medicare Advantage plans (at least Humana, Aetna, and AARP/United Healthcare) pay for up to 150 days of Skilled Nursing (aka nursing home). The first few days are usually $0 copay, then the rest are a certain rate per day. All MAPD, Medigap, and Medicare PFFS (aka "basic") will end at 150 days or if the patient does not improve (whichever comes first).

TS
 

Talent312

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Last year, Aetna sold DW's drug plan to Wellcare. The renewal premium increased.
We found another Wellcare plan thru the Medicare website for much less ($13.20).
It was another Wellcare plan. This confused them, but we called and worked it out.
 

dago

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Luanne, do you have plan F or G for a supplemental?
I went on my state teachers retirement supplemental and it seems like I’m getting little bills here and there. No major problems, just regular visits etc.
We put my husband on Plan G with Anthem so he could have the Silver Sneakers, but if Plan F is better I want it switched
The difference between Plan G and plan F is Plan F pays all deductibles and co-pays. With Plan G you pay the Part B deductible and I$20 co-pays to the doctor and $50 co-pay for ER. The premiums for plan G are substantially lower. You need to estimate how many times you think you will see a doctor and how many times you think you might go to ER, and compare all your out-of-pocket costs between the 2 Plans. I looked into it, and for me although the the total out-of-pocket for Plan G was less than Part F, it was not enough for me to make the change., so I stayed with Plan F. I have had Plan F for 10 years and,other than the premiums I have never paid a dime for any health services. I just feel more comfortable with not having to worry about co-pays when I go to the doctor. For 2020 they are not offering Plan F anymore, so this may be a moot point.
 

dago

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Plan F

I don't know much, or really anything, about Silver Sneakers. But, I thought it was only available with some Medicare Advantage plans, not with a Medicare Supplement. It doesn't even look like Silver Sneakers is available where I live. I do know the gym I go to is "covered" by some Medicare Advantage plans.
I thought the same thing. But I have Plan F from UHC(AARP discount) and I DID have Silver Sneakers, but they took it away last year.
 
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FYI, for 2021, MAPDs (and possibly PDP) will offer a Diabetes plan. For a higher premium, you'll get Insulin for $35. It will be a whole new plan, you will not automatically get the Diabetes benefit. Insurance agents like myself won't know anything until September for plans offered in Annual Enrollment.

Todd S
 

topmom101

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Todd S., thank you for that information. My brother has a Medicare Advantage plan thru UHC and is diabetic. I know he pays over $150/month for his insulin. He’ll be happy to hear this news.

I am so glad to be a part of this knowledgeable group of people.
 
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Like I said, I have no idea what the premiums will be, but I have a feeling they will save $$$ overall. That is the premise of insurance, spreading loss over all members.

Todd S

Todd S., thank you for that information. My brother has a Medicare Advantage plan thru UHC and is diabetic. I know he pays over $150/month for his insulin. He’ll be happy to hear this news.

I am so glad to be a part of this knowledgeable group of people.
 

Talent312

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Todd S., thank you for that information. My brother has a Medicare Advantage plan thru UHC and is diabetic. I know he pays over $150/month for his insulin. He’ll be happy to hear this news.

Good news for insulin users.
OTOH, there are a lot us diabetics using alternative brand-name drugs (Jardiance) who will pay thru the nose. I'll have to cover my deductible ($485) each year with very first refill, yet the annual cost will be less than "better" drug plans.
 
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As I said before, most Insulin-based products will be $35 or less with the new plans. The big question is premiums. It's similar to when President GW Bush signed the Part-D law, it is not run by the government, it is regulated by CMS. CMS is telling insurers like UHC, Humana, etc to create Diabetes-specific MAPD and PDP plans that significantly cut Insulin copays.

TS
 
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