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G26ster wrote:

Beiruty wrote:UT SW should accept medicare patients.

They accept Original Medicare, not my Medicare Advantage HMO. There's a big difference between Original Medicare and a Medicare Advantage HMO.

The difference is that Original Medicare is accepted at most hospitals/doctors but you are responsible for the 20% of Part B costs unless you also have a Medicare (Medigap) supplement plan. Under a Medicare Advantage HMO, you;'re not responsible for that 20% BUT you are restricted to doctors and hospitals in that HMO. The two should never be confused.

I know that by discussing Medicare I have taken this subject away from the topic, but it's been so valuable to my Medicare questions that I've taken to reading the whole thread and this caught my eye. It is (truly) interesting that when you buy an Advantage program, you essentially opt-out of Medicare! You have instead a private insurance plan, subsidized and regulated by the US govt, but it's not Medicare any more!

Just last night I asked some friends (man and wife) older than me "do you have Supplement/Medigap or Advantage plans" and they didn't truly know, and one of them was in the healthcare profession for many years! They were lucky in that they moved easily into the plans they have by their employers, and are happy with them, but I am amazed they didn't know the type of plans they have though I guess I shouldn't be! Could anything BE made more complicated?



Oh of course, the ACA is more complicated! And let's put the IRS into a key role in Obamacare--we all know how competent THEY are!

BTW today I am leaning heavily toward a Medigap Plan N, which AFAICT is exactly the same as Plan F (covers everything) except for office visit copays but is cheaper such that for as many times as I see Drs in a year (fewer than 5 time max) to make the $15-50 copays is cheaper than the increased cost of Plan F over Plan N.

G26ster wrote:

TomsTXCHL wrote: Tell me specifically please what decision I must make correctly now that if I don't I am "out of luck for life"?

It's pretty simple. Should you choose to drop your Advantage plan after you are diagnosed with a major condition, and switch back to Original Medicare to avail yourself of top hospitals and specialists, you will not be able to get a supplement plan with your major pre-existing condition as you are no longer in a "Guaranteed Right" position. That Guaranteed Right window closes 6 months after you "Originally" sign up for Medicare Part B. It, except for a few rare events, never opens again. Of course, as rotor says, if you can guarantee that you will die quietly in your sleep, go Advantage plan.

TomsTXCHL wrote:Well MD Anderson is one I suppose but WHO KNOWS: what kind of specialized care I might need down the road, and whether any plan I sign-up for today will cover X-Y-Z tomorrow.

That's the whole point. Since you can't guess "what kind of specialized care I might need down the road, and whether any plan I sign-up for today will cover X-Y-Z tomorrow" selecting Original Medicare opens up using just about ANY major medical center and top specialists in the country for just about any condition you can think of.. Advantage severely limits the specialists and facilities you can use.

Thanks a lot G26ster, that is the clarity I was looking for. I will [try to] confirm this of course (not believing everything I read on the Internet ) but your comments make sense to me and it looks like if I add ANYTHING to my Parts A and B it will be a Supplement plan F. And probably a prescription plan too--I have only one somewhat pricey med right now but again who knows what the future may bring.

Thank you!

rotor wrote:You must make the decision about going advantage plan or regular medicare. If you go regular medicare you need a supplement (medigap) and a plan D (Rx plan). With regular medicare you should be able to get into any facility in the country. With an Advantage plan you will be limited. An Advantage plan will cost less up front but when you need surgery expect to pay more ( probably much more) than regular medicare. So, if you can guarantee that you will NEVER need major medical care and will just die quietly in your sleep go Advantage plan. If you are like most of us and will run up big bills go regular medicare.

Well, I DON'T "run up big bills" but then too of course I don't know what is going to happen in the future, and as I think I've said the idea about Medigap that it "protects your wealth" in the event of catastrophic illness is what caught my eye about it (honestly I had not even been considering it! guess I'd answered the questions wrong when surfing online about this as exchanges "recommend Advantage plans" for me) and I can afford it so these comments are helping me a lot! Thank you!

G26ster wrote:Ask anyone trying to sell you an Advantage plan one hypothetical question. "If I develop cancer down the road, is MD Anderdson Cancer Center (or really and nationally recognized cancer hospital) in my network?" If the answer is no, you may want to consider Original Medicare w/Medigap supplement, and a Part D drug plan.

Well MD Anderson is one I suppose but WHO KNOWS: what kind of specialized care I might need down the road, and whether any plan I sign-up for today will cover X-Y-Z tomorrow.

I have not talked to any sales people just yet because I want to get educated first, so I am surfing like crazy on this. Unfortunately it does not seem like the critical info I might need is online, namely "is thus and such clinic or doctor in-network for this plan" and "does Dr. XYZ accept medicare".

Tell me specifically please what decision I must make correctly now that if I don't I am "out of luck for life"?

rotor wrote:My personal recommendation is to be on regular medicare, get a medicare supplement from a good company ( USAA was for me) and there are various priced and featured supplements so you have to study this, buy a plan D prescription (in my area the choice was Humana (didn't like) or AARP (was good and you don't need to join AARP). There are time limits that you must do this and I believe that if you do this right when you turn 65 you are OK but later on you can't or are penalized. The advantage plans in my opinion are not the way to go.

Thanks I've been trying to understand Medigap (Medicare Supplement) and two things stop me dead-in-this-track:

1. A Plan F covers everything (but prescriptions) but it does not cover routine physicals for example. At least from what I've read. It's only for if/when you get sick (which I very rarely have).

2. A provider that doesn't accept basic Medicare won't accept Medigap. I don't know how many of what kind of Drs don't accept Medicare but this alarms me.

What caught my eye about Medigap is that it "protects your wealth" by paying everything (at least, w/certain Plan Fs) so you don't have to worry about a catastrophic illness draining all your resources. Yeah the prices go up at certain points but frankly these look easy to me.

Maybe paying out-of-pocket for regular checkups is no big deal, I just dunno.

G26ster wrote:Thanks Rotor. makes sense. Yes, although my Advantage HMO has been really great since 2008 even with some pretty heavy duty bills and procedures, when it comes to a catastrophic illness, and you want the best possible doctors available in the country, they fall short, as you are restricted in doctor and hospital choice to those in your network. My advice to anyone soon to retire (65 and over) is to avoid a Medicare Advantage Plan, and take advantage of the 6 month "guaranteed right" window after signing up for Medicare Part B, where you cannot be turned down for pre-existing conditions of any kind with a Medigap supplement plan. If you miss this 6 month window, you are basically out of luck for life, with a few rare exceptions, in getting a supplement should you become a victim of a catastrophic illness.

I guess your comment that I bolded above is directed at folks with a nasty preexisting condition? Sorry don't understand you.

I am about to turn 65, am already on SS thus I've been automatically signed-up for Parts A and B, and am being absolutely hounded by insurance agents representing the various Advantage plans. And in surfing the medicare web site itself, I find that I can sign-up for most/any of these plans directly thru the medicare.gov site without apparently dealing with ANY of these "exchange" companies (e.g. extendhealth/oneexchange from Tower Watson).

I don't know WHAT the heck to do, but I've got a couple months still to think and study on it. As healthy as I am (knocks on wood) I still have a GP and a Urologist and a Dermatologist and a Gastroenterologist and <who else> so am thinking still that I want an Advantage plan and co-pays of $15-50 bucks and some minimal prescription help.

mojo84 wrote:I firmly believe a lot of the reason we're in this situation we're in now is because we started expecting insurance to cover routine and minor medical expenses.

Zackly right--insurance USED TO be something you bought "just in case" you had an unexpected problem and needed assistance with the bucks. But now it's morphed (warped?) into something entirely different hasn't it.

What we have had instead is "group healthcare" where you pay monthly and an "insurance company" e.g. Blue Cross has negotiated discounted services and pays providers for those because you're a card-carrying, dues-paying client of their.

This arrangement shouldn't be called "insurance" IMHO. And as for the Affordable Care Act, I do prefer the alternate names people have used, for example in this very thread...

As Chris Mathews explained on one of the morning talk shows about a month ago, the Democrats have been trying to institute Universal Health Care since Roosevelt. Under Obama they were going to get it come hell or high water.

Sorry to hear of your shocking situation Beiruty. I do wonder how many people are going to say "screw it, I can't afford this--let 'em come after me with penalties."