12 Replies Latest reply on Mar 12, 2014 8:22 PM by Sharon

    CHOOSING A MEDICARE REPLACEMENT PLAN

    SHARI0904
      Hi,
       
      Does anyone have any recommendation for a Medicare Replacement plan?  Is there any plan that is better than the rest?
        • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
          JerryD
          Do you mean an "Advantage" plan? Initially, an Advantage program seemed quite cheap given my good health, but the local provider did not accept it. So I went with a Medicare and supplemental insurance approach. I chose Blue Cross as the supplemental due to reputation and previous experience. I have been happy so far but have had few medical issues.
           
          After a few years it finally occurred to me that the choice was much more complicated. I found that I must always weigh whether my health might turn bad. The big gottcha is that once it does you had better be in a plan that you can live with for a long time, maybe life. The reason is that changing plans or insurers usually gives the new plan or insurer the right to put you through underwriting, another word for rejecting you due to your poor health. This results in the existing plan as the life choice unless you accept their underwriting restrictions.
           
          Put some time into the decision is my advice.
            • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
              Michigander
              You might want to check out the November issue of Consumer Reports which just came out.  They rate Medicare advantage plans by state.  I was pleased to discover that my plan was ranked third in my state out of over ten.  Which plan to choose is a very personal decision based upon your specific medical situation, but the rankings can give you some good impressions.  I'm in my first year on Medicare and found it very helpful before I signed up to attend a number of information/sales sessions presented in my area during the previous open enrollment period.  No one session gave me all of the information I needed to decide, but together they all helped me a lot.  If you're lucky, you'll find at least one where you'll be able to spend quality time with a very knowledgeable sales rep who will give you some personalized attention and answers to your questions.  At the sessions I attended, people seemed sincerely interested in me making a good decision for myself.  I made a decision to go with a local provider which gave on site seminar-type information sessions rather than dealing with distant companies by telephone and the Internet.  I was able to do that because I live in a large metropolitan area where a number of plans found it feasible to hold such meetings.  Of course, you should do what's most comfortable for you.
                • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                  JerryD
                  I have been out-of-touch for a while, in the UP of Michigan actually. Did any of these (Advantage?) representatives clearly explain your rights AFTER the first year for going into other Medicare/Medipack/Part D plans should you experience some serious medical issues? Do you have to go through underwriting for the new choice? Can they put limitations on your eligibility or coverage? Etc.?
                   
                  It would be very helpful if you could share your knowledge. Some of us, including me, failed to see the actual implications of choosing an Advantage program while in good health and then finding that the on-going deductibles and out-of-pockets add serious costs, potentially permanent because of plan change restrictions, to such plans. I could be wrong about these complex choices so your efforts could benefit many of us.
                    • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                      ChuckH
                      I chose straight Medicare with a Medicare supplemental insurance policy for the following reasons:1. No insurance company can tell me who I can see. With straight Medicare, you can go to any provider. Medicare Advantage plans are like HMO's and PPO's with lists of preferred providers. You may pay big time outside of their network.2. You can always go to a Medicare Advantage plan from traditional medicare, but you can't go back, from Medicare Advantage to traditional Medicare - you may not be able to get the supplement policy (due to preexisting conditions - sound familiar?)The traditional Medicare route is more expensive, especially if you're healthy (which I am) but, in my judgement, it's worth it to keep my options open for treatment down the road. Another note of caution; be sure that the provider you're considering will take the Medicare payment as payment in full for their service.
                        • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                          maggiew
                          I absolutely agree. Medicare is like our Blue Cross/Blue Shield and Horizon Blue Shield "back in the day." We didn't have to jump through hoops and pay for a entire layer of cost due to medical managers. Bah humbug. Most important, we have AARP United Healthcare medigap insurance - they pay all co-pays and deductibles. We love it, and we love Medicare. I wish my adult children could have it, too. 
                  • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                    Michigander
                    Since I've been in one HMO or another ever since the 1980's, I've always had co-pays and sometimes have had deductibles, so I knew what I was getting into when I chose my Medicare Advantage plan (HAP Senior Plus HMO-POS extended network).  I don't know anything about changing plans in the future or future underwriting requirements.  If I was told, I don't remember.  Sorry I can't help with that.
                    • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                      Pinkie1947
                      Hello....I just posted a comment today about the Kaiser Permanente Medicare Advantage plan on another string. I'm not sure if you saw it so I thought I would post it on this string in case you are interested.  This plan is not offered in all states though, so you may or may not be eligible. I also wanted to look into the Humana Medicare Advantage plan but it's not offered in my state.
                      ~~~~~~~
                      I will be retiring at the end of the year and have been looking into insurance plans. My employer retiree plan is ridiculously expensive, which is very annoying. They are one of the largest employers in the state, so you'd think they could come up with some better priced insurance plans!

                      Because I had a short break in service while working here for over 27 years, I do not yet have that magic number of “80” (age + years of service) that gives one the best retiree price for supplemental insurance. 
                       
                      Working one more year would get me to the magic number of  "80" but at age 65, I am really ready to retire now, and don't want pay that high premium for the in-house retiree plan.

                      I recently attended a seminar on the Kaiser Permanente Medicare Advantage plans. The plans offered both have a 5 star Medicare rating, look affordable and work directly with Medicare to maximize your coverage and benefits.

                      As I understand it, you pay for Medicare Part B and then pay a small monthly amount for the Kaiser Permanente side of the coverage which includes a Part A and a Part D benefit.
                       
                      This year there was no charge for their standard plan, but next year (Jan. 2014) the fee will be $14.00 per month for the standard plan (called Medicare Plus Standard Option) and $113 per month for the High Option plan.

                      Obviously it IS an HMO plan - which you may or may not like the idea of. There are a lot of advantages to the patient, but there may also be some disadvantages too (not all doctors are participating,so it might not work for you if you want to stay with your long time doctor who is not in their network, etc.) 

                      So far, I like the idea of it. The price is right….and you can change after one year during the next open enrollment period, if you decide that you don’t like it. I would really like to hear from anyone who currently has this specific plan (or other Medicare Advantage plans in general.)

                      Thank you! Chris
                        • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                          JerryD
                          Pinkie1947 said...
                          Hello....I just posted a comment today about the Kaiser Permanente Medicare Advantage plan on another string. I'm not sure if you saw it so I thought I would post it on this string in case you are interested.  This plan is not offered in all states though, so you may or may not be eligible. I also wanted to look into the Humana Medicare Advantage plan but it's not offered in my state.
                          ~~~~~~~
                           
                          ...

                          I recently attended a seminar on the Kaiser Permanente Medicare Advantage plans. The plans offered both have a 5 star Medicare rating, look affordable and work directly with Medicare to maximize your coverage and benefits.

                          As I understand it, you pay for Medicare Part B and then pay a small monthly amount for the Kaiser Permanente side of the coverage which includes a Part A and a Part D benefit.
                           
                          This year there was no charge for their standard plan, but next year (Jan. 2014) the fee will be $14.00 per month for the standard plan (called Medicare Plus Standard Option) and $113 per month for the High Option plan.

                          Obviously it IS an HMO plan - which you may or may not like the idea of. There are a lot of advantages to the patient, but there may also be some disadvantages too (not all doctors are participating,so it might not work for you if you want to stay with your long time doctor who is not in their network, etc.) 

                          So far, I like the idea of it. The price is right….and you can change after one year during the next open enrollment period, if you decide that you don’t like it. I would really like to hear from anyone who currently has this specific plan (or other Medicare Advantage plans in general.)

                          Thank you! Chris
                          Chris, a couple of comments about our experiences with both Advantage and Advantage HMO coverage. First, I too was really interested in the Advantage approach. To tell the truth, it was the cost that I liked. Unfortunately, when I couldn't get that coverage locally and I finally looked deep enough under the covers, some of the problems with this approach over Medicare + Supplement + Part D coverage began to appear.
                           
                          As I understand it, you can indeed switch out of an Advantage coverage after the first year for any reason. You can also get out if the exact program is no longer offered. The problem is health issues don't always occur on this time line. As I see it, the potentially quite high deductibles and yearly out-of-pocket costs can add up year after year should any serious and long-lived health issue happen and you can't get out.
                           
                          A special case is if your drug overage. Under Part D you can choose a new drug coverage suitable to your current medical issues each and every year. True, you may have to wait a year but then you can fix it according to your current drug needs by selecting the best provider for your specific drugs. This happened to me. I developed a serious medical issue that was treated in January right after my new Part D coverage kicked in. I paid a bit more for a year but I fixed that at the next enrollment by using the Medicare site to research drug providers according to my needs.
                           
                          Another special case arises related to the HMO option of Advantage. I note from your profile that you are in WI which may or may not be an issue for you that wouldn't be a problem if you were in NYC or Boston or other places with the best medical coverage in the nation. However, if you are like us and have a smaller medical system, the HMO option may prevent your treatment at the most advanced hospitals in the nation because they are not part of the coverage. This was struck home very hard to us when we accidentally went to an Advantage enrollment and stuck around out of courtesy. We heard a couple talking about their severe medical issues that just popped up early that year. Their issues required major medical expertise and in one case treatment by one of only a handful of hospitals in the nation (think Mayo Clinic or the Cleveland Clinic) and these were NOT in our HMO since they were out-of-state and not part of our modest hospital system. We hope that they took our quiet advice to bail on the HMO option and to get into a Medicare + Supplement +Part D coverage while they could so that they could access these resources and possibly better manage their drug needs.
                           
                          I hope that you can see that the choice can't be on cost only. Medical issues can be very complex and our apparent good health may fail us, much to our surprise. Think it through carefully and consider some worst case scenarios that become much more probable as we age. Good luck with your selection process!

                            • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                              Pinkie1947
                              Hi Jerry - thanks for your comments. I'm not from Wisconsin though....not sure where you saw that. I live in Maryland and worked for a major teaching institution for 27 years, 22 of them were in the jobs that were considered 'staff' positions  and although they required a college degree, they didn't pay that great. During the last 5 years though, I finally got a position that paid a good wage in a senior staff category, which had different retirement plan. However my main pension is based on those 22 years of employment, plus my Soc. Security. I just got my first pension check, which turns out to be $1068  per month. My Social Security is going to be a bit more and they take the Part B payment out of that. If I wanted to take the retiree health insurance plan, my share of the cost would be $386 - about 1/3 of my pension. Wow...great benefit! So the $15 per month for Kaiser Permanente was very appealing and so far it's been ok. So I will see how it goes....compared to the other AARP plans for Medicare advantage, this one doesn't have a deductible. I had KP a few years ago and liked it at the time, so hopefully this will be as good. According to the booklet and the consultant I talked to, the Part D from Medicare works with KP and provides even better benefits so I hope I won't have any problems. Good luck to you too.
                                • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                                  JerryD
                                  Ooooops. Got WI from the person you responded to in post 8 of this thread instead of you. 

                                  Is Johns Hopkins one of your choices in your KP HMO coverage? That is right up there with the Mayo Clinic that I swear by from several experiences there. As I recall from US News evaluations they are neck-and-neck for best system in most treatment categories in the US.
                                   

                                    • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                                      Pinkie1947
                                      Yes, I that is the retirement health plan I am eligible for I liked my primary care doctor, but the cost of staying with that plan is just outrageous to have to pay 1/3 of my pension check to be in that plan. Incidentally I worked for Hopkins for the last 27+ years and had their self-administered health insurance plan for most of that time. My family and I had both good care and awful care there. I would not rate them number one though - it truly depends on the actual area (Internal Medicine, Cardiology, etc,) and how the office staff feels that day. I realize that Kaiser Permanente is not available in all areas of the country and health care provided at any place can vary, but because several of the residents in the training program that I managed, actually moonlight at Kaiser in their time off, and they spoke highly of the organization and the care provided to the patients......that actually tipped my decision as opposed to going with one of the other Medicare Advantage plans. I did go over some scenarios prior to signing with them as you suggested because I did have kind of fluke heart issue about 4 years ago and wanted to see how that would be handled. In addition, if I wanted to see a non-KP specialist, I would pay out of network difference as I have done over the last 27 years. (And having worked in cardiology at Hopkins for 7 years, I know who I would want to see) We'll see how I like it after a few months!  
                                        • Re: CHOOSING A MEDICARE REPLACEMENT PLAN
                                          Sharon
                                          I have had Kaiser for over 7 years, 5 of them on Medicare.  
                                          All my friends and myself and husband are very happy with it and the choices of doctors.
                                          I had no trouble at all finding specialists .
                                          A friend had heart surgery, and although he did have to drive 100 miles to the cardiac specialized hospital, his insurance paid the costs of hotel, etc and he got excellent care.
                                          They have the best specialists in certain locations and regular doctors in every locations.  Many specialists (skin, allergy, heart, etc.) travel between offices during the week so they can cover a wide area.
                                          Never had a problem getting an apt the day I needed it if I were ill.
                                          They also have Urgent Care hours in the evenings.
                                          The advantage of Kaiser is not just low cost, but the fact they NAG you into being healthy, exercising, eating right, loosing weight and keeping under control all your "preexisting" conditions.
                                          I'm very grateful.
                                          We all need to be "nagged" every now and then.
                                          All the doctors have access to ALL MEDICATIONS AND DIAGNOSIS which is very important in treating the whole person.
                                          They also offer classes, free of charge, for heart, asthma, diabetes, high blood pressure, and other medical  conditions...to prevent conditions from ever beginning.
                                          No wonder Kaiser got top marks in the national scoring. And you do get to pick your own doctor and keep him/her.