Here we go again. Stick with regular Medicare or jump ship to an Advantage plan?

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Here we go again. Stick with regular Medicare or jump ship to an Advantage plan?

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I’ve had the high deductible Medicare Plan F for a year. I’ve had one ER trip for an ear infection and one doctor visit. Honestly, I’ve been very fearful of seeing any specialists or doing more for my health than just the very basics. I still pay for Part D and a Medigap Plan.

The only “advantage” I can see to sticking with the regular Medicare is that if I want to switch plans I won’t have to fight to get back on Medicare. It does not provide me with medications, vision care, a dental plan or the Silver Sneakers program.

Any opinions or advice for 2020? Thanks.

Medicare Advantage Plans Medicare Open Enrollment

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My husband turns 65 in December and I'm wading through this stuff now. I know nothing about Medicare but I saw my dad's 2020 Medicare book came in the mail so I 'borrowed' it and I need to start reading. I still work full-time and my husband is currently insured by my group insurance. It is pretty good and very reasonably priced. I work for a healthcare organization who also has a health insurance side. They sent my husband a bunch of information about Medicare Advantage plans (they have a 5-star rating - don't know if that matters). I'm really thinking it may be best to keep him on my insurance.

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Not in the US, so no help at all with the various plans.

I do want to comment on it costing your $20/month for vision coverage. What are you getting for $240 per year? Does this include glasses? It is just eye exams? Would it cover treatment for Cataracts, Glaucoma etc?

I am asking because if it just covers eye exams and glasses, you may be better off paying on your own. Here an Eye exam is $125.00. I get one every 2 years. Glasses I get every 2 years too. I have two different prescriptions and every second year I replace one of them as needed.

Here in Canada though surgery for Cataracts is fully covered as is surgery for MD.

I cannot imagine how challenging it is to have to navigate US health care insurance.

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Tothill, in the US cataract surgery is almost always covered by our health insurance not our vision insurance. I

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Ahmijoy, I would find an insurance broker that specializes in Medicare.

My dad pays less annually for his supplemental premiums than he would for his deductibles on an advantage plan.

A broker can pull up reports and has resources that we don't, so they should be able to help you find the best plans for the best financial burden.

That is what I recommend.

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Thanks, Is. This is what I did last year and may call her again this year. It’s a company called “Remedigap” and I speak with the owner, Joann. She is very knowledgeable on every plan and every change to these plans. After having this so-so coverage this year, I think I may need to bump it up a bit.

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My loved one 80+ transferred to a Medicare Advantage plan and just found out that Equilis (for blood clots )will cost $450+ to have it refilled.
The information is second hand. He is going without for two days now.

For him, wondering if one could purchase a prescription plan separately that would cover special medications?

I was told if anyone is on Medicare, A Medicare Advantage Plan, or a Medicare Prescription plan they do not qualify for the Equilis $10 co-payment card.
I was told to have the medical DPOA person for my loved one call the manufacturer 800 number for their offer if one cannot afford their medication.
It irked me that I would need to be the DPOA just to call them for general info, not giving any patient stats or names.

I say this because Ahmijoy had discussed the medication Equilis before.

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Send, my husband was put on Eliquis in his former rehab facility two years ago. He was on Coumadin at $6.00 a month but his PT/INR levels were all over the charts and I failed miserably at his home blood checks. When I did research on this Med and found it would be almost $500 a month with not much help from Part D, I just about fell out of my chair. We are paying $44.00 a month now, but we chance falling into the donut hole and having to pay full price.

If you go to the Bristol-Meyers-Squibb website, the manufacturer of this drug, you can apply for help. It didn’t work for us, but they are very helpful if you call them and ask for help.

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Amhijoy...Plan F is NO deductible (none) and no co-pay

maybe you mean Plan G? Or plan N?

like I said. The only plan that has NO copay and No deductible is Plan F, and after December 31 of this year...no one may enroll. If you already have it, you can keep it...but if you leave it you cannot come back to it.

the Medicare and You booklet just mailed out has the laid out...in the middle of the book and only a couple pages. It is clear that the government is pushing the other plans including Medicare advantages pretty hard

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Thanks, Katiekate. I was under the impression I did have Plan F, but the high deductible version. I’d have to revisit the HCM or my policy to make sure. I am tempted with the Advantage but I know if I should need hospitalization, we could wind up owing thousands. Something to think about.

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My heart is with you as you try to navigate this Open Season mess. I have heard that Advantage plans aren't very good. I have no personal knowledge.

I have Medicare with GEHA (Government Employees Health Association) as my secondary. It isn't cheap but I have no co-pay and can go to any doctor I wish. My prescriptions are covered. I also have GEHA dental coverage for $105.00 extra quarterly. I will keep it as long as I can possibly afford it. I love not having to spend time being "referred" by my primary to a specialist. I can go where I want when I want.

Hubby has Medicare and AARP plus his union insurance for his prescriptions. He loves the freedom too.

Neither one of us has had our bills questioned. I take that back, in 1982 before I was a senior, I had GEHA question the cost of my Chemotherapy. I told them I had shopped around and all the doctors charged the same. I would be glad to provide documentation. They said, "no problem, we didn't realize the Palm Springs area was that expensive."

I don't know where you are, A lot of seniors in my area like Kaiser. Many like Scan.

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After December 31 of this year, if you are not on plan F...you cannot ever be on. If you leave plan F, it is forever.

(plan F is NO deductible and NO co-pay)

medigap is just another word for Medicare part B supplemental.

i do not plan to give up plan. F. I don’t want to even think about what if I suddenly need ER help. I am quite healthy, but accidents do happen

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This is not the Plan F that everyone talks about. This is the “high deductible “ version of this plan. It’s not much different from Medicare Advantage”.

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Ahmi, I think decisions such as the ones you're facing are really dual faceted: your health, and that of your husband.

Do you feel that the plans you have now adequately provide for your husband's needs?   It seems like you have a lot of care available, but not necessarily what you require for yourself.
Could you realistically drop back to standard Medicare with just Medigap and Part D?   I'm wondering also why you only avail yourself of necessary, issue specific treatment?   Given your situation, I think even a basic checkup might help.   You're probably aware as are most of us that the position you're in can put you at high risk yourself.

As to the vision, dental plan or the Silver Sneakers program, what I did when I selected a dental plan was compare plans, add in out-of-pocket costs for the last several years and project which might be needed the most as age progressed.   I ended up with the AARP Delta Dental Plan. It did provide good basic coverage at the time, and coverage did expand over the years.   But so did the premiums.   Did we save money? Yes.

As to vision, that's changed a bit in the last years as designer glasses have been pushed and additions to basic lenses have changed.    I don't recall blue light protection options years ago, but they are available now.  Cataract surgery will be covered by Medicare.   Cost of transit won't be though.

Do you want and would you have time to use a Silver Sneakers program?   I've found that Senior Centers also offer some basic workout classes as well, at reasonable costs. And some hospital PT departments offer them as well.

I think I would calculate based on past years what the noncovered costs would be, and how much you would save (or not) if you went with an Advantage plan.

And from what I've read, there may be situations in which an Advantage plan doesn't cover extraordinary costs, or experimental surgery...issues like that.

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Thank you. Your post makes a lot of sense.i would probably not use the Silver Sneakers program. But I pay about $20 a month for vision care.

I totally understand what you’re saying. And, at some point, who knows what could happen to me? It’s pretty much a crapshoot, isn’t it?

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Choosing one's own doctor can be an advantage to having traditional or stand alone Medicare. Seeing any doctor, even a specialist without a referral by an HMO,
can, imo, save many months and save your life.

Fearing to be able to afford the balance due, or the co-payment, high deductible,
or not even knowing what that will be for several months is an irresponsible way to run a medical insurance program, imo. And I understand avoiding medical care for that reason.

If you can afford a supplemental plan along with Medicare, that would be great, imo. I am not sure if a supplemental plan is the same as a medi-gap plan. There are so many plans, all designed to take our money and allow or disallow the payment to our healthcare providers. It is so corrupt, no wonder so many doctors will no longer accept Medicare. And if a doctor does accept Medicare, they triple bill just to get approved and paid their fees. This speaks to the reason medical costs are so high, but only in part. Not entirely the doctor's fault, imo.

The government would like to force everyone into a managed care plan (HMO), imo. I do not believe we "lose" our Medicare by signing up for an HMO, we just lose the use of it outside the managed care plan. In other words, we "assign" the Medicare benefits to the HMO plan. You can call it what you will.

Hey...I could be wrong, or be misinterpreted by what I just wrote.
I advise everyone to make their own post, about their own opinions, and not attack mine. It is not that I cannot take criticisms or correction, it just gets old when people follow me around just to diss whatever I write because they think they are an expert or better informed than I am. Some are just negative haters, and not trying to help me or anyone. imo. I don't correct them when they are wrong, because it would be a fight so they could "prove" they are right, imo.

I admit to just being one of the confused millions of Americans who can no longer obtain or pay for good medical care, so I am going without, now subscribed to an
HMO.

During this OPEN ENROLLMENT PERIOD, I may find out just how hard it will be to get back my traditional medicare, that has become unaffordable for me.

Sad.

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Here we go again. Stick with regular Medicare or jump ship to an Advantage plan?

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