Sprinter-Forum    
 

Go Back   Sprinter-Forum > General Forums > Off Topic > Health

Health Self-Health Discussions, not Sprinter issues or you-know-what Zone discussions.


 
Thread Tools Display Modes
Old 10-17-2019, 07:40 PM   #1
Aqua Puttana
Poly - Thread Finder
 
Aqua Puttana's Avatar
 
Join Date: Apr 2008
Location: The Falls of Niagara, USA
Posts: 25,012
Thanks: 12,881
Thanked 14,086 Times in 8,953 Posts
Default Medicare Supplement and Advantage Plans

First. I'm not an expert on insurance. You need to do your own research. There are a staggering number of Youtube videos available about choosing your Medicare insurance.

I did learn this basic information though.

When you initially sign up for Medicare and choose a Supplement Plan there is no medical qualification needed. As long as you stay with Supplement Plans, to the best of my knowledge, there is no medical questionnaire or qualification needed to change within Supplement Plans.

Once you sign up for an Advantage Plan, to change over to a Supplement Plan there may be medical questions and qualifications for you to be accepted. It is not automatic. The insurance company can turn down your application.

To be honest I didn't really think about any choices that I had when I was changed over to Medicare. Since turning 55 years old my retirement health insurance has been through my former employer. It is a large corporation which has always provided good health insurance benefits.

When I reached 65 years old my insurance choices were limited to one Medicare retiree plan. I just let my insurance change over without any investigation.

I have a cousin who told me they had additional Medicare insurance with ZERO monthly premiums. That sounded odd to me so I investigated it. It turns out that they have a Medicare Advantage Plan which is HMO based. The cost is indeed zero for the monthly premium. The HMO care is also regional. A bit of investigation showed me that given our frequent travel and some other factors a Medicare Advantage Plan is not what I would choose. A Supplement Plan would be a better fit.

Then I discovered that I had been signed up for a PPO Advantage Plan because I just went with my retirement medical coverage. Isn't that just ducky.

Sorry. This story is probably too long already.

To help keep it short.
After a bunch of investigation I learned that the Medicare Advantage Plan which I'm in is probably a good deal for our needs. It is PPO (Preferred Provider Organization) based. Because the company I worked for is so large, the plan extends to all states. I don't believe that all Medicare Advantage Plans do extend to all states though, except for emergency care ***.

Can I get out of my Advantage Plan and over to a Supplement Plan?

The good news for me changing over is that I live in New York State. It turns out that New York State and Connecticut have State Laws which allow a person on a Medicare Advantage Plan to change to a Medicare Supplement Plan with no medical qualification. There are also some other NYS laws which I consider favorable for my Medicare choices. Not all states have such provisions.

The bad news is that the rates in New York State are generally higher than some other areas.

The conclusion for our situation.
At first I was worried about being stuck in an Advantage Plan. Generally an Advantage Plan can be fine, but some of the plans don't cover serious illnesses such as cancer and chemotherapy well.

My reviews and comparison of the present Advantage Plan benefits convinced me to stay with what we have. The costs and coverage are actually quite good. Not a small part of my decision is that I'm leery to leave my corporate sponsored retirement benefits.

If I have reason in the future to go to a Supplement Plan, thanks to the NYS Medicare laws, I can do so during an open enrollment period (October 15 - December 7) fairly easily. If I do change to a Supplement Plan it won't take effect until January 1 of the coming year.

Added Note:
In September the insurance companies start bombarding senior citizens with warnings that the October 15 to December 7 Open Enrollment needs your attention. That is only true IF you are #1) In an Advantage Plan AND #2) You WANT to change plans/insurance companies.

The open enrollment doesn't apply if you are on Original Medicare with Supplemental Insurance. There are firms who specialize in Medicare Insurance. Check some Youtube videos to see if any of those Independent Brokers appeal to you.

My long winded post aside.
Before signing up for any Medicare Insurance Plan be certain to carefully check into the options available to you. Some Advantage Plans (HMO) don't give good general coverage when traveling. Emergency care can be limited. *** It is very easy to make a decision which can send you down the path of needing to stay with an Advantage Plan when you would rather change to a Supplement Plan.

Do your research. That is especially true for when you initially enroll in Medicare. The initial age 65 Medicare enrollment has some choices which can be a one time opportunity.

vic

***
Emergency Care can be very limited. If you have a Medicare Advantage Plan that is HMO regional based, once you are stable it may be up to you to get yourself back to the region where your regional Advantage Plan medical providers are. Another option is to pay for the medical care where you are out of pocket.
__________________
DAD NAS (N. Amer. Spec) 2004 140 2500 >330,000+ mi. Arctic Whitewash Brush-tone Grey
2006 Freightliner 140 2500HC >183,000+ mi. Arctic Whitewash (Spotted Snow Leopard accents)
"My opinion and worth everything you'll never pay for it." assumed.
Anyone can hold the helm when the sea is calm. Publilius Syrus
"There are only 10 types of people in the world: Those who understand binary, and those who don't." HaWiiLuVeR
16 ounces of unnecessary prevention can be worth a pound of manure.

Last edited by Aqua Puttana; 11-01-2019 at 05:34 PM.
Aqua Puttana is offline   Reply With Quote
The Following User Says Thank You to Aqua Puttana For This Useful Post:
Bobnoxious (10-23-2019)
Old 11-01-2019, 12:46 AM   #2
Aqua Puttana
Poly - Thread Finder
 
Aqua Puttana's Avatar
 
Join Date: Apr 2008
Location: The Falls of Niagara, USA
Posts: 25,012
Thanks: 12,881
Thanked 14,086 Times in 8,953 Posts
Default Re: Medicare Supplement and Advantage Plans

An update.

I'm scheduled for right Total Replacement Hip THR surgery Dec. 10. I scheduled with the same surgeon who did my left hip 10 years ago.

My insurance provider sent me a letter dated October 20, 2019 that my surgeon was no longer included in the plan as of Oct. 1, 2019 "Out of Network". To keep my choice of doctors I needed to apply by October 1, 2019. The letter was dated Oct. 20, 2019 and received after that!!! I have surgery scheduled for Dec. 10.

The good news is that because our advantage Plan is a PPO and not an HMO type, it doesn't matter. I can stay with my surgeon. (Who I trust and have confidence in by the way.)

I wasn't going to update with this information, but then it came to me that the situation may have some relevance. If you are in an HMO type Advantage Plan, your doctor of choice can be quite quickly "Out of Network". With a PPO Advantage Plan the risk of that happening is lower, but I suspect is still in the realm of possibility.

As I said in the first post. I am not an expert. You need to do your own Medicare research.

FWIW.

vic
__________________
DAD NAS (N. Amer. Spec) 2004 140 2500 >330,000+ mi. Arctic Whitewash Brush-tone Grey
2006 Freightliner 140 2500HC >183,000+ mi. Arctic Whitewash (Spotted Snow Leopard accents)
"My opinion and worth everything you'll never pay for it." assumed.
Anyone can hold the helm when the sea is calm. Publilius Syrus
"There are only 10 types of people in the world: Those who understand binary, and those who don't." HaWiiLuVeR
16 ounces of unnecessary prevention can be worth a pound of manure.
Aqua Puttana is offline   Reply With Quote
The Following User Says Thank You to Aqua Puttana For This Useful Post:
autostaretx (11-01-2019)
Old 11-02-2019, 08:01 PM   #3
flman
In Transit
 
Join Date: Mar 2009
Location: America, Great Again!
Posts: 18,253
Thanks: 5,487
Thanked 4,879 Times in 3,751 Posts
Default Re: Medicare Supplement and Advantage Plans

Vic you are like an old Sprinter, a few new parts and it keeps on going.
flman is offline   Reply With Quote
The Following User Says Thank You to flman For This Useful Post:
Aqua Puttana (11-04-2019)
Old 11-04-2019, 01:02 AM   #4
Aqua Puttana
Poly - Thread Finder
 
Aqua Puttana's Avatar
 
Join Date: Apr 2008
Location: The Falls of Niagara, USA
Posts: 25,012
Thanks: 12,881
Thanked 14,086 Times in 8,953 Posts
Default Re: Medicare Supplement and Advantage Plans

Quote:
Originally Posted by flman View Post
Vic you are like an old Sprinter, a few new parts and it keeps on going.


Replacement parts have definitely allowed me to keep my quality of life.

vic
__________________
DAD NAS (N. Amer. Spec) 2004 140 2500 >330,000+ mi. Arctic Whitewash Brush-tone Grey
2006 Freightliner 140 2500HC >183,000+ mi. Arctic Whitewash (Spotted Snow Leopard accents)
"My opinion and worth everything you'll never pay for it." assumed.
Anyone can hold the helm when the sea is calm. Publilius Syrus
"There are only 10 types of people in the world: Those who understand binary, and those who don't." HaWiiLuVeR
16 ounces of unnecessary prevention can be worth a pound of manure.
Aqua Puttana is offline   Reply With Quote
Old 11-04-2019, 01:53 AM   #5
tinman
 
Join Date: Aug 2009
Posts: 588
Thanks: 179
Thanked 247 Times in 183 Posts
Default Re: Medicare Supplement and Advantage Plans

Quote:
Originally Posted by Aqua Puttana View Post


Replacement parts have definitely allowed me to keep my quality of life.

vic
Truly wonderful what a bit of titanium here and there can do. I've had a few defective parts removed, some stuff moved around, but unlike a lot of folks around me haven't gone bionic yet. Hope it goes very well for you.
__________________
2006 LT FreeSpirit 210B. DAD
tinman is offline   Reply With Quote
The Following User Says Thank You to tinman For This Useful Post:
Aqua Puttana (11-04-2019)

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump



All times are GMT. The time now is 12:24 PM.


Powered by vBulletin® Version 3.8.9
Copyright ©2000 - 2019, vBulletin Solutions, Inc.