Medicare Part C

[JD8]

I do not pay anything for the insurance or have a big deductible. I think it more than balances out.

I have known people with A,B and a supplement that have lost their home etc because of much higher out of pocket expenses than we had.

Can you give a more specific example, because that sounds like hearsay.

There are no out of pocket expenses for A+B and a plan F other than Premium. Which wouldn't cause you to lose your house.

So plan F went bye-bye in Oklahoma as of Jan 1 for new plans. Plan G will be the most comprehensive plan. It's still a considerable step up from Medicare Advantage.

I have horror stories for days about people with Medicare Advantage plants and in fact, I have actually seen someone that had cancer lose their home with a MA plan, because of the copays they weren't aware of when they signed up. They would've walked out with a $0 bill under traditional medicare plan + supplement. Then of course you have a more limited network of doctors you can go to and then a more limited medicinal formulary coverage.

 

[JD8]

Yes you have to be careful. Since I am not 65 but on disability a supplement plan for me was ridiculous. Plan C covered us both really well since neither one of us had spend much time in a hospital. Few months latter, blam, almost 2 months in for me. Still very happy with what we had to pay.

Part C..... not Plan C. Big difference.

Medicare Part C is Medicare Advantage where you sign your medicare rights away to an insurance carrier.

Medicare Supplement Plan C is one of the different supplemental plans you can buy in addition to your Part A and Part B.

 

[TeleStratMan]

Don't know a lot of the details because I'm still working but my Grand daughter is a social worker at a local Hospital. She told my wife and I to stay AWAY from Medicare Advantage Plans because she has to deal with them on a regular basis in her job. She said they are horrible and told us when its time to select keep the regular medicare and purchase a supplemental policy.

 

[RickN]

Can you give a more specific example, because that sounds like hearsay.

There are no out of pocket expenses for A+B and a plan F other than Premium. Which wouldn't cause you to lose your house.

So plan F went bye-bye in Oklahoma as of Jan 1 for new plans. Plan G will be the most comprehensive plan. It's still a considerable step up from Medicare Advantage.

I have horror stories for days about people with Medicare Advantage plants and in fact, I have actually seen someone that had cancer lose their home with a MA plan, because of the copays they weren't aware of when they signed up. They would've walked out with a $0 bill under traditional medicare plan + supplement. Then of course you have a more limited network of doctors you can go to and then a more limited medicinal formulary coverage.

All I know is they told me they had regular Medicare and a supplement plan, hit some kind of out of pocket expenses and lost pretty much everything. You do not really ask to many digging questions when a friend is hurting.

As far as Part C treating us, our yearly expenses have been much lower, no monthly fee, so far every doc we have wanted to see has been covered, and Humana has covered everything the docs recommended without fuss including home health and physical therapy care when I needed it. I have a Humana rep that still comes by to see me, tries to help whenever the pharmacy screws up, signed us up for free gym memberships, etc, etc, etc.

They even sent some meals when I first got out of the hospital and could not stand up long enough to cook. I do have some copays but nothing worse than I had with regular insurance and no issues like I had with regular Medicare. I am still seeing the same doc I have had for 20 years.

Oh and they pay us to do regular checkups, etc. Enough to offset most of our regular docs copays.

 

[JD8]

All I know is they told me they had regular Medicare and a supplement plan, hit some kind of out of pocket expenses and lost pretty much everything. You do not really ask to many digging questions when a friend is hurting.

As far as Part C treating us, our yearly expenses have been much lower, no monthly fee, so far every doc we have wanted to see has been covered, and Humana has covered everything the docs recommended without fuss including home health and physical therapy care when I needed it. I have a Humana rep that still comes by to see me, tries to help whenever the pharmacy screws up, signed us up for free gym memberships, etc, etc, etc.

They even sent some meals when I first got out of the hospital and could not stand up long enough to cook. I do have some copays but nothing worse than I had with regular insurance and no issues like I had with regular Medicare. I am still seeing the same doc I have had for 20 years.

Oh and they pay us to do regular checkups, etc. Enough to offset most of our regular docs copays.

Yeah, there's something else to that story.

One thing you have to realize is that you're not relaying an apples to apples comparison. Medicare supplemental plans are considerably different and costly for those on disability UNDER 65. You simply cannot compare your situation to someone that has turned 65 and is enrolling in traditional medicare, in which there is a night and day difference compared to MA plans.

Food for thought.....

Medicare Supplemental plans CANNOT deny a claim for a Medicare approved treatment. If it is approved, Medicare pays, and then tells the Medicare Supplemental carrier what to pay. They have no choice in the matter because they are a piggy back to Medicare.

Now, Medicare Advantage plans can deny treatment all day long. They've denied coverage, stalled, and refused to pay physicians, who in turn try to bill the patient. In which it's in their best interest to keep you healthy, but it's also within their best interest to deny or stall claims. Several of the carriers have gotten in trouble for this.

Here's the OTHER downside....once you're enrolled in Medicare Advantage... it's REALLY tough to get out of it... because they will underwrite you to get BACK into Traditional Medicare Supplemental plans.

https://www.medpagetoday.com/special-reports/exclusives/83661

So keep in mind, to everyone turning 65..... once you turn 65 you have rights. You can enroll in traditional Medicare and the Medicare supplemental plans HAVE to take you if you choose one. They CANNOT underwrite you outside of age and being a smoker, but they have to enroll you by law. So if you have a condition when you turn 65, choose wisely.

 

[RickN]

My wife is over 65, and is on the same plan as I am. She loves it. And Humana has not denied ANY treatments or coverage outside of rehab the first time the hospital discharged me. They said I was not ready to be discharged and they were correct. A week later I was back in the hospital.

Personally I think the supplemental plans are the government trying to make insurance companies money and are pretty much a rip off. I am very happy with my plan and have no desire to switch to a higher cost regular plan and supplement.

 

[JD8]

My wife is over 65, and is on the same plan as I am. She loves it. And Humana has not denied ANY treatments or coverage outside of rehab the first time the hospital discharged me. They said I was not ready to be discharged and they were correct. A week later I was back in the hospital.

Personally I think the supplemental plans are the government trying to make insurance companies money and are pretty much a rip off. I am very happy with my plan and have no desire to switch to a higher cost regular plan and supplement.

Whether or not your wife is on the same plan has no bearing to what I'm saying. YOU just said you were under 65 and on disability. Is this correct? I'm referring to you complaining about the cost of Supplemental plans. Well, if you priced them out while on disability, under 65, then that changes the whole ball game. You're trying to compare your situation to others trying to get on Medicare correct? If so, the disability plans you were pricing out were significantly more expensive than someone turning 65 and joining Medicare and adding a supplement. I remember them to be double if not triple IIRC. Again, apples to oranges. Your situation isn't the common one. They are allowed to price in or underwrite a person on disability that has enrolled in Medicare under 65 because they have to offer you a plan.

Finally, your theory on Supplemental plans makes no sense whatsoever. If anything MA plans make more sense for the government as they pay the carrier a fee to take over your healthcare. If MA plans were detrimental to Medicare, it wouldn't exist, period. IF anything, the government is looking to get out of it's responsibility with MA plans.


But let's take one example from Humana..... one of their cheapest plans @ $0 (Funny thing is after signing away your rights...you still have to pay Part B premium @ ~$144 a month)


HumanaChoice PPO
PPO H5216-139

IncludedMedical

Deductible: $198.00

Primary care coinsurance: 20%

Specialist coinsurance: 20%

Maximum out of pocket: $6,700.00


IncludedPrescription drug

Deductible: $435.00


So you're right back to what Medicare pays, with a limited network and a higher drug deductible. Oh and you'll need an in-network referral so that will be fun too.

 

[RickN]

Sorry but neither mine or my wife's deductibles, etc came to that. We have a $20 copay for a doctors visit and $45 for a specialist. If I remember correctly, the ER copay was $98. Also our prescription deductibles are not much higher than with regular and a supplement. As far as in network, All of OU, Mercy, and Integeris system and others are in Network so not a problem there.

And my theory on supplemental is they are just like the insurance payoff under Obamacare. "Private Insurance is bad!" wink, wink here have a few billion taxpayer dollars. In other words, supplements are just a way to help insurance company. I know my wife's supplemental cost close to $200 a month a couple years ago and mine was well over that. That is on top of the $144, copays, deductibles, etc.

I am not saying Part C is a good fit for everyone, I am saying check closely before some smooth talking insurance rep sells you a supplemental policy that may cost you more in the long run.

Oh, I have not lost any rights under Humana. None at all. I do not know if it is because they changed it a year or so ago or what, but we are very happy with it.

 

[RickN]

Speaking of apples to oranges, or you talking about an HMO plan? Mine is a PPO if that makes a difference.

 

[Slim Deal]

Sorry but neither mine or my wife's deductibles, etc came to that. We have a $20 copay for a doctors visit and $45 for a specialist. If I remember correctly, the ER copay was $98. Also our prescription deductibles are not much higher than with regular and a supplement. As far as in network, All of OU, Mercy, and Integeris system and others are in Network so not a problem there.

And my theory on supplemental is they are just like the insurance payoff under Obamacare. "Private Insurance is bad!" wink, wink here have a few billion taxpayer dollars. In other words, supplements are just a way to help insurance company. I know my wife's supplemental cost close to $200 a month a couple years ago and mine was well over that. That is on top of the $144, copays, deductibles, etc.

I am not saying Part C is a good fit for everyone, I am saying check closely before some smooth talking insurance rep sells you a supplemental policy that may cost you more in the long run.

Oh, I have not lost any rights under Humana. None at all. I do not know if it is because they changed it a year or so ago or what, but we are very happy with it.

Maybe we will have the opportunity to discuss something similar to this in two years. I was in the health insurance business before retiring and what JD8 said is right. Part C is Obammycare, by using Medicare Part C you basically did sign your rights to choose, they just haven't slapped yoi around.... Yet.

I wouldn't know what to recommend for your health insurance but I do know that Plan F does exactly what is published in the brochures.
1. $0.00 deductibles. Absolutely $0.00 in deductibles and NO co-pays. Period.
2. You get sick ... they pay
3. You have Any Kind of surgery at any Hospital .. They Pay
4. You o to your DR ... they pay
You pay the premium, you have no out of pocket expenses.

Plan F does not cover eyewear , optometrist, and does not have a prescription drug coverage.
I know from my experiences in 2013 and 2016, 2 heart surery's, over $300,000.00. All hospital, all surgeons, specialists, emergency room, emergency room doctors and half a dozen of the walk in and bill you doctors was paid for. The only paper I saw was from United Healthcare showing they had paid everything. Not a single penny for me to pay.

Of course my rates go up each year, starting in March my premium is 189.00 monthly. But I have absolutely no out-of-pocket expense. I will mention that being Cherokee I do get my prescription drugs free.

I wish you and everyone else the best in this crapmire.