Mar 19, 2019

Medicare health insurance

Greetings to those of you 65 and older!  Just came from the office where we purchase our Medicare Advantage Plan.  A few tidbits just in case it's pertinent to your situation.  Normally the open enrollment period for signing into a Medicare supplement or advantage plan is October - December.  For this year (and maybe the only year) the enrollment period was extended to March 31, 2019.  We are considering changing our plans and found out that Highmark is offering a supplement that is all inclusive such as the AARP United Health Care (they are not making this offer).  No co-pays, no drug plan, more expensive than advantage plans BUT for this period only, it is open to all.  You have heart problems, cancer, diabetes, kidney problems, they will still take you at the entry rate.  Otherwise, those conditions may exclude you from acceptance or the premium will be higher.  I am in western PA (Highmark is based in Pittsburgh) and it is not available everywhere, but if you need to go to a full coverage Medicare supplement, check with a fringe benefit/insurance specialist and see if there is any other company with this offer.

Main difference between the two types of plans...

Advantage plans

co-pay for doctors
co-pay for hospital stays and ER
co-pay for lab work
co-pay for CT and MRI (over $200)
20% co-pay for chemotherapy (yep)
no co-pay for diagnostic (mammo, colon)
Some routine dental exams
Vision allowance once a year
Rx plan included in cost
Cheaper than supplement
No health history required, no age differential

My Highmark Freedom Blue PPO plan's monthly cost is $78 as is Mark's. Advantage plans are the same price for everyone without restriction for joining.  Some like Coventry are highly rated and have $0 monthly cost.

Supplemental plans

no co-pays for anything
100% hospital coverage
100% chemotherapy coverage
No dental
No vision
Rx plan is separate
High cost, but complete medical coverage
Health history required, price based on age

My monthly fee at 67 would be $134, Mark at 70 would be $151, Rx plans $34 per month.  I am considering this move because I don't know where my diagnosis will lead and I will be accepted now.  Every year I will have the option to go back to the advantage plan if I choose.  Coventry plan is widely accepted and highly rated, what I would save in monthly cost would go towards drugs, which in either plan would still be high.  I would hit the "donut hole" in 6 months.  So I have a decision to make very soon and you know how poorly I do with that task.  Switching to a full supplement is like having car or house insurance.  You have to pay whether the coverage is used or not, but have the peace of mind knowing you're covered fully.  Who knows if a hospital stay or diagnosis is in the future?  Then again, the money saved in policy cost every month can be set aside and used for the extra expense incurred in advantage plans.  It's a dilemma I tell 'ya!

If you need to change to a cheaper, better, or more inclusive advantage plan or supplement, you still have until the end of March to do so.  Many of our friends did not know about the extended enrollment period so thought I would mention it.  And I did.


Rugs and Pugs said...

That just makes my head hurt. Good luck deciding!

Carol said...

Oh, no--I'm going to have to face this before the end of the year. It all sounds SO complicated! I wonder if there are people you can hire to advise you? Thank you for the breakdown, Marly--and good luck to you!

Ginny said...

Good for you, thinking through this so carefully! I’m not 65 yet, but we went through this with my late husband. When he was diagnosed with incurable cancer which caused kidney failure, he was declared disabled, and after a certain amount of time on SSDI you are forced to go on Medicare. Due to circumstances beyond the scope of this discussion he had no choice as to which advantage plan to go on, and it was a nightmare. His chemo often cost many thousands of dollars a month and if it were not for organizations like the Leukemia and Lymphoma Society and their co-pay assistance programs we would have lost everything. When it comes time for me to go on Medicare I already know I will not get an advantage plan. There are just too many unknowns and I’d rather play it safe. Guess that was long-winded but I just wanted to say that your reasoning is very sound and matter-of-fact. Getting older isn’t for the faint of heart.

Barb said...

Thanks for the heads up! Good luck. My DH worked for GE and they had a company help the retired folks find the best plan for their needs.

Sherry said...

This is our first year on Medicare and I had to have a supplement to help with my chemo I have 8 days each year. Trying to figure all this out can be a very mind numbing experience.

TheCrankyCrow said... you mean I am going to have to save some brain cells to figure this stuff out when I get to the golden years??? (Yeah, almost, but I’m gonna milk the “not quite” for as long as I can LOL). I just am looking forward to not paying $2000/mo in premiums for just ME with a $7000 deductible to boot. And, after all that, being told my injections cost $3700 every three weeks. Yikes.

Related Posts Plugin for WordPress, Blogger...