Medicare Questions (medical, plan, hospital, doctor)

[southernpearl]

Hi -I will become eligible for Medicare a little later this year, and I'm overwhelmed by the decisions that must be made. I've read the manuals and attended a brief class at our local tech school. They both helped with the basics, but they were not much help in making the tough decisions. For several reasons, I have decided to go with Medicare Supplement (Medigap) rather than Medicare Advantage. For those who have recently gone through the experience, I would appreciate your help with a few questions.

(1) I have a few chronic medical issues, so I am leaning toward either plan F or plan G. Good idea/bad idea? How in the world did you decide which company to use? I understand all plan F's are the same, regardless of which company you use, but that costs may vary widely between companies. Do you just talk to every company you can find that offers the plan you wanted, then choose the lowest cost?

(2) I've read other comments on here where people complained about the service from their Medicare Supplement company. It may sound like a dumb question, but why should I be concerned about service? As I understand the system, my doctors will bill Medicare, then the Medicare Supplement company will be notified and they will handle the balance, per the plan I choose. I don't understand where customer service comes into play.

(3) I've received a lot of mail from AARP (I'm a member) regarding their Medicare Supplement plans. I realize the plans are really from United HealthCare and just promoted by AARP. When I talked to my doctors' offices or friends, everybody seems to be pretty positive when I mention AARP plans, but when I bring up United Health, everyone is very negative. That totally confuses me. If anyone is using a Medicare Supplement plan they got through AARP, what's your experience?

Thanks very much for your help!

[wehotex]

Originally Posted by southernpearl

Hi -I will become eligible for Medicare a little later this year, and I'm overwhelmed by the decisions that must be made. I've read the manuals and attended a brief class at our local tech school. They both helped with the basics, but they were not much help in making the tough decisions. For several reasons, I have decided to go with Medicare Supplement (Medigap) rather than Medicare Advantage. For those who have recently gone through the experience, I would appreciate your help with a few questions.

(1) I have a few chronic medical issues, so I am leaning toward either plan F or plan G. Good idea/bad idea? How in the world did you decide which company to use? I understand all plan F's are the same, regardless of which company you use, but that costs may vary widely between companies. Do you just talk to every company you can find that offers the plan you wanted, then choose the lowest cost?

(2) I've read other comments on here where people complained about the service from their Medicare Supplement company. It may sound like a dumb question, but why should I be concerned about service? As I understand the system, my doctors will bill Medicare, then the Medicare Supplement company will be notified and they will handle the balance, per the plan I choose. I don't understand where customer service comes into play.

(3) I've received a lot of mail from AARP (I'm a member) regarding their Medicare Supplement plans. I realize the plans are really from United HealthCare and just promoted by AARP. When I talked to my doctors' offices or friends, everybody seems to be pretty positive when I mention AARP plans, but when I bring up United Health, everyone is very negative. That totally confuses me. If anyone is using a Medicare Supplement plan they got through AARP, what's your experience?

Thanks very much for your help!

AARP IS United health. Since they're all standardized, simply pick the least expensive one.

[TFW46]

I was in the same quandry as you. So I called two insurance salesmen and emailed each of them the list of prescriptions I was taking, as well as my medical issues, what kind of coverage I wanted and the maximum I wanted to pay in monthly premiums.

I figured I'd see what program each of them suggested for me. I think they get a bonus based on what plan you sign up for under them and I was curious to see if they suggested the same program. They did...but one was much more responsive to me than the other and I signed up under him.

[Robyn55]

We used a local insurance agent who specializes in this stuff and represents a lot of companies. He spread everything out on the dining room table - and answered all the questions we had. My husband wound up with plan J (since discontinued) from AARP/UHC (in part because none of our parents ever had a problem with AARP/UHC).

Service is important - especially if your carrier doesn't pay your provider or you on a timely basis. Note I said *you*. There are some providers that accept Medicare patients - but not Medicare (we use the Mayo Clinic and it's in that category). When a provider does this - it notifies Medicare about your services. If the services are covered - Medicare sends you a check. Medicare notifies your Medigap carrier - and it sends you a check too. Mayo sends bills to you - and you pay Mayo directly. FWIW - a provider who works this way can bill 15% above normal Medicare rates. My husband's plan J covers this 15% (don't know whether other plans do).

I have no idea whether what Mayo does is common. All I know is we go to Mayo . We always get the Medicare/Medigap checks well before we get a bill from Mayo. If our Medigap carrier was a slow pay - we wouldn't be happy campers. Robyn

[southernpearl]

Originally Posted by Robyn55

We used a local insurance agent who specializes in this stuff and represents a lot of companies. He spread everything out on the dining room table - and answered all the questions we had. My husband wound up with plan J (since discontinued) from AARP/UHC (in part because none of our parents ever had a problem with AARP/UHC)...

Thank you very much for the helpful info. I'm trying to find a local independent agent that's knowledgeable on this stuff, but so far their responses have been lukewarm.

Were you able to get the AARP Medigap policy through the independent agent or did you end up dealing directly with United Health? Have you been satisfied with their performance and service?

I appreciate your comments on "service". I had read about the potential for 15% excess charges, but I did not realize that Medicare/Medigap ever paid directly to the member. That's good info worth knowing, and I appreciate you pointing that out.

[Ariadne22]

Fwiw, I have UHC Advantage. UHC pays my chiropractor within 15 days of when they get his bill. I usually see him at least twice a month. I've also called UHC with routine questions. Once got a rep that wasn't too bright, but the others I've talked with have been fine. If, as someone on this board posted AARP IS UHC, UHC had better behave.

[Robyn55]

Originally Posted by southernpearl

Thank you very much for the helpful info. I'm trying to find a local independent agent that's knowledgeable on this stuff, but so far their responses have been lukewarm.

Were you able to get the AARP Medigap policy through the independent agent or did you end up dealing directly with United Health? Have you been satisfied with their performance and service?

I appreciate your comments on "service". I had read about the potential for 15% excess charges, but I did not realize that Medicare/Medigap ever paid directly to the member. That's good info worth knowing, and I appreciate you pointing that out.

We bought the policy through the agent. Same price for us - and he helped us a lot.

My husband has been on Medicare for a little over a year now - and we haven't had any problems. Robyn

[Keeper]

I know how you feel as I felt the same way when I first went on Medicare. Depending on where you live will depend on whether or not you can get AARP advantage plan. They do not offer it where I live. I have a AARP medigap policy now. I stated in another post that the reason I did not continue with BC/BS advantage plan was out of pocket cost. I pay a little more per month but I have no co-pays. I had to get a drug plan too.

If you are in good health and have extra money to pay for co-pays then you might like the Advantage plan as long as your doctor is on the list. I had a problem with them paying for a nurse anesthetist because she was not listed on my plan but worked for the hospital.

Feel free to ask questions.. we have a lot of good folks here

[Robyn55]

Keeper - Since we have never been on Medicare Advantage - I never really thought about all the stuff regarding possible co-pays and deductibles. They apparently can be significant cost-wise (and I'm sure mileage will vary depending on the plan and the person). With traditional Medicare/higher end Medigap plans - you pretty much know exactly what you're going to pay. At least with plans like the one my husband has. In the year since my husband has been on Medicare - he has paid exactly $17 out of pocket for medical care (he got an injection in his knee at Mayo because it hurt - don't know why Medicare denied that tiny part of a fairly large claim for his MS workup - but it wasn't worth 3 hours of our time to find out).

I'll also point out that - for a lot of Medicare patients (although not my husband) - the nature of one's drug coverage can be as important or more important than the coverage for medical services. I don't know how different Medicare Advantage plans cover drugs (or whether they cover them at all) - but there are lots of different Medicare part D plans. Which may or may not cover the drugs you need.*

FWIW - our agent sells not only the higher priced Medigap plans - he sells Medicare Advantage plans too. And I'm sure he could sit down with anyone and go through a lot of "what if" scenarios. Taking into account things like fixed monthly premium costs versus unknowable co-pays and deductibles (that would probably vary year by year depending on how much medical care you need). He did tell us that a lot of his clients go for Medicare Advantage - because the known monthly costs are lower. They didn't take into account the unknown costs that were unpredictable.

And to show you how screwy things can get. My 92 year old father has an old discontinued Medigap policy he thinks is great (although he can't remember why). He pays $246/month for it - and it doesn't cover his 15% extra at Mayo (he moved up here near us 5 years ago after my mom died). My husband's policy costs $172 and it covers the 15%. I refuse to get into the fray (and I especially refuse to spend 40 hours reviewing his Medigap policy and his current options). So I have told my father to meet with our agent and go over his options. But he refuses. Thinks his plan is the greatest. Although - like I said - he can't remember why .

BTW - I live in the greater JAX FL metro area - and will be glad to give anyone in my area the name of our agent if you send me a DM. But I'm sure there are equally good agents all over the country. And the way I found our agent was I asked 2 agents I used for other kinds of insurance - agents I liked and respected - to recommend agents in this particular insurance area. Spoke to both on the phone. One sounded kind of dumb and uninformed - the other sounded kind of smart and well-informed. And I went with the one who sounded kind of smart and well-informed . Note that I perhaps have an unfair advantage. Since - when I was practicing law - about 1/3 of my practice was insurance coverage litigation. I am more likely than an average person to know smart from BS when it comes to insurance talk . Robyn

*This is slightly OT - but - with regard to drugs. If you are taking some relatively cheap generics - e.g., many blood pressure meds - statins - etc. - look at your bottom line. You might have a $10 co-pay with your part D or other plan if you buy the meds 30 days at a time when you can buy 100 for $9.99 out of pocket. We get a lot of our meds at Costco - and it computes all of this automatically. Gives us the best deal. Plus - buying the 100 for $9.99 saves money in gas costs.

[wehotex]

Originally Posted by southernpearl

Hi -I will become eligible for Medicare a little later this year, and I'm overwhelmed by the decisions that must be made. I've read the manuals and attended a brief class at our local tech school. They both helped with the basics, but they were not much help in making the tough decisions. For several reasons, I have decided to go with Medicare Supplement (Medigap) rather than Medicare Advantage. For those who have recently gone through the experience, I would appreciate your help with a few questions.

(1) I have a few chronic medical issues, so I am leaning toward either plan F or plan G. Good idea/bad idea? How in the world did you decide which company to use? I understand all plan F's are the same, regardless of which company you use, but that costs may vary widely between companies. Do you just talk to every company you can find that offers the plan you wanted, then choose the lowest cost?

(2) I've read other comments on here where people complained about the service from their Medicare Supplement company. It may sound like a dumb question, but why should I be concerned about service? As I understand the system, my doctors will bill Medicare, then the Medicare Supplement company will be notified and they will handle the balance, per the plan I choose. I don't understand where customer service comes into play.

(3) I've received a lot of mail from AARP (I'm a member) regarding their Medicare Supplement plans. I realize the plans are really from United HealthCare and just promoted by AARP. When I talked to my doctors' offices or friends, everybody seems to be pretty positive when I mention AARP plans, but when I bring up United Health, everyone is very negative. That totally confuses me. If anyone is using a Medicare Supplement plan they got through AARP, what's your experience?

Thanks very much for your help!

I am an insurance agent- full disclosure. Many ppl tend to think of AARP (United Healthcare) as a default policy. "AARP recommends it, so it MUST be good. the truth is that AARP will sell out its name to the highest bidder. Years ago, the "AARP" policies were actually Prudential insurance which paid the bribing fee. Don't be fooled. You may be paying more for that fancy name. There are other highly rated companies that may offer you lesser premiums. It pays to shop around. I don't know about So Carolina. Here in Texas, Oxford Insurance med supps are very competitively priced. You might want to check out Gerber, Forethought, Mutual of Omaha. United Health gets a bad rap for its HMO plans (Medicare Advantage) mostly. When you select a Med supp, the med supp MUST pay the bal due on what Medicare pays. You may call 1-800-medicare and/or your State Dept of Insurance if that's not the case. They will follow up. I've written many letters over the years on my members' behalf to them.
Plan F is the most commonly sold. It will cover all deduct, coinsurances and the 15% overage for certain providers. The least expensive Part D is the Humana Walmart (currently $14.80/mo here in Tex). I don't know what your financial situation is like, but you should find out about qualifying for the Low Income Subsidy for meds (Part D). currently, it is no more than $1361/mo gross income and some $16,000 in assets.