Medicare Advantage

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RebLem
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Medicare Advantage

Post by RebLem » Fri Nov 15, 2013 1:42 am

My medical insurance is being changed by the State of Illinois effective February 1, 2014. Effective then, I will be covered by a UnitedHealthCare Medicare Advantage PPO plan. You can go to any doctor who accepts Medicare; no distinction as to in and out of network providers. The state calls it "Total Retiree Advantage Illinois or TRAIL." Isn't that cute?

Anyway, all this is prelude. The booklet contains this curious statement:

The service area for our plan is nationwide, which includes all 50 states and the District of Columbia except for DeKalb, Gibson, Warren, Morgan, and Shelby Counties in Indiana.

What?
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John F
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Re: Medicare Advantage

Post by John F » Fri Nov 15, 2013 2:27 am

I'm in a UnitedHealthCare Medicare Advantage program, and it's a very good deal - though not the same deal as you have. My particular flavor does limit me to a particular network of physicians and specialists. That's been no problem because the ones I've seen have been quality doctors.
John Francis

jbuck919
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Re: Medicare Advantage

Post by jbuck919 » Fri Nov 15, 2013 2:50 am

RebLem wrote:My medical insurance is being changed by the State of Illinois effective February 1, 2014. Effective then, I will be covered by a UnitedHealthCare Medicare Advantage PPO plan. You can go to any doctor who accepts Medicare; no distinction as to in and out of network providers. The state calls it "Total Retiree Advantage Illinois or TRAIL." Isn't that cute?

Anyway, all this is prelude. The booklet contains this curious statement:

The service area for our plan is nationwide, which includes all 50 states and the District of Columbia except for DeKalb, Gibson, Warren, Morgan, and Shelby Counties in Indiana.

What?
Does this fall under the heading "parts of states still in rebellion against the union?"

Not to demean your coverage, Rob, except that I'm about to (but nothing personal), "trail" is very appropriate since that is what the US does and would continue to do even if Obamacare were working perfectly. What else is wrong with this picture? Medicare coverage is limited to the US. Recently I read that the program would save money if Medicare were portable to retirement places like Mexico, because the cost of health care is so much lower in other countries. Just put that one to the test to see once again if the priority of anyone in Congress is really saving money and reducing health care costs as opposed to channeling maximum profits to the profit-making sector of the health care industry.

BTW, I assume that your new plan means you have opted for Medicare Part C. AFAIK states have no power to dictate restrictions on ordinary Medicare A and B, which is what my mother has (though she has the unique program Tricare as a supplement). United Health Care is the company that underwrites the various plans offered and dignified as "AARP supplemental." They are good plans, but the key word is "supplemental." It would seem that they also offer Part C comprehensive plans which work for many people.

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jbuck919
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Re: Medicare Advantage

Post by jbuck919 » Fri Nov 15, 2013 3:17 am

John F wrote:I'm in a UnitedHealthCare Medicare Advantage program, and it's a very good deal - though not the same deal as you have. My particular flavor does limit me to a particular network of physicians and specialists. That's been no problem because the ones I've seen have been quality doctors.
Oh come on, now. You live in greater New York City. Of course any network is going to have quality doctors. In fact across the country that is rarely the issue. The issue is what happens when the best choice for care takes you out of network (which includes hospitals as well as practitioners), or (for younger people) what happens when one must switch plans and therefore possibly networks. I could actually have had a much cheaper Health Exchange plan if I had wanted to start anew with still excellent doctors (one of them was my mother's PCP). I will in effect be paying a premium to keep my current PCP and the associated specialists, plus the three hospitals I can conceive of needing short of Sloan-Kettering.

There's nothing remarkable about it. All one has to do is hit the right keys at the right time and the instrument plays itself.
-- Johann Sebastian Bach

John F
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Re: Medicare Advantage

Post by John F » Fri Nov 15, 2013 3:40 am

jbuck919 wrote:
John F wrote:I'm in a UnitedHealthCare Medicare Advantage program, and it's a very good deal - though not the same deal as you have. My particular flavor does limit me to a particular network of physicians and specialists. That's been no problem because the ones I've seen have been quality doctors.
Oh come on, now. You live in greater New York City. Of course any network is going to have quality doctors.
So you say. How do you know? When I turned 65, a Lincoln Center volunteer who was a retired doctor told me differently and recommended the program I'm in because of the quality of its doctors. She didn't warn me off any other Advantage programs because there was no point in doing so, but I believe there is a qualitative difference and she knew what she was talking about.
jbuck919 wrote:The issue is what happens when the best choice for care takes you out of network (which includes hospitals as well as practitioners).
Fortunately that hasn't arisen - my health needs have been very simple so far. But the best hospitals in the city are in my provider's network, and indeed one of my criteria for choosing my primary care physician was that he be affiliated with at least one and preferably more of these. (Another was that his office be located in a part of Brooklyn that I can easily get to by walking or public transportation.)
jbuck919 wrote:I could actually have had a much cheaper Health Exchange plan if I had wanted to start anew with still excellent doctors (one of them was my mother's PCP). I will in effect be paying a premium to keep my current PCP and the associated specialists, plus the three hospitals I can conceive of needing short of Sloan-Kettering.
It's good that you have that option and can afford it. To each according to his/her needs.
John Francis

RebLem
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Re: Medicare Advantage

Post by RebLem » Fri Nov 15, 2013 5:00 am

My plan allows me to go to any doctor who accepts medicare assignment. I can go to a specialist without a referral. I am probably going to be able to go to my favorite dermatologist, who my present plan took away from me last year. Only a $100 annual deductible, with some copays and a maximum out of pocket annual expense of $1300, which does NOT, however, include the copays for prescriptions. Most services, including hospitalization, are at a 90/10 basis--I pay 10% up to the $100 annual deductible and $1300 out of pocket expense--after that, the plan pays 100%--except, as I say, for meds, for which there is always a copay.

Yes, I would prefer to be able to use the plan abroad as well. I am concerned that the plan especially discriminates against Puerto Ricans or US Virgin Islanders who may have been Illinois employees but desirous or returning to Puerto Rico or the US Virgin Islands in retirement. I think Luis Gutierrez may have something to say about this.

But I am still wondering what is so special about these 5 counties in Indiana. I have checked each of them, and they are scattered through the state--in fact, none of them is contiguous with even one of the other five. I'm just really wondering what is going on with these counties.
Last edited by RebLem on Mon Nov 18, 2013 7:04 pm, edited 1 time in total.
Don't drink and drive. You might spill it.--J. Eugene Baker, aka my late father
"We're not generating enough angry white guys to stay in business for the long term."--Sen. Lindsey Graham, R-S. Carolina.
"Racism is America's Original Sin."--Francis Cardinal George, former Roman Catholic Archbishop of Chicago.

jbuck919
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Re: Medicare Advantage

Post by jbuck919 » Fri Nov 15, 2013 9:21 am

RebLem wrote:But I am still wondering what is so special about these 5 counties in Indiana. I have checked each of them, and they are scattered through the state--in fact, none of them is contiguous with even one of the other five. I'm just really wondering what is going on with these counties.
Have you thought about researching where the remaining strongholds of the John Birch Society are? :wink:

There's nothing remarkable about it. All one has to do is hit the right keys at the right time and the instrument plays itself.
-- Johann Sebastian Bach

lennygoran
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Re: Medicare Advantage for John F

Post by lennygoran » Sat Feb 22, 2014 6:30 am

John F wrote:I'm in a UnitedHealthCare Medicare Advantage program, and it's a very good deal - though not the same deal as you have. My particular flavor does limit me to a particular network of physicians and specialists. That's been no problem because the ones I've seen have been quality doctors.
John noticed this while reading the news this morning--thought it might interest you? Regards, Len

http://www.politico.com/story/2014/02/m ... 03797.html

John F
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Re: Medicare Advantage

Post by John F » Sat Feb 22, 2014 7:10 am

The Times has a story about this too:

http://www.nytimes.com/2014/02/22/us/po ... ments.html

I've no idea what effect this might have or even if it's actually going to happen. When/if it does, then I'll think about it.
John Francis

Febnyc
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Re: Medicare Advantage

Post by Febnyc » Sat Feb 22, 2014 8:10 am

jbuck919 wrote:BTW, I assume that your new plan means you have opted for Medicare Part C. AFAIK states have no power to dictate restrictions on ordinary Medicare A and B, which is what my mother has (though she has the unique program Tricare as a supplement). United Health Care is the company that underwrites the various plans offered and dignified as "AARP supplemental." They are good plans, but the key word is "supplemental." It would seem that they also offer Part C comprehensive plans which work for many people.
Part "C" is the so-called Medicare Advantage - which, per se, limits the insured to a network of providers. The premiums vary by insurer. It sits behind Parts "A" and "B" and covers almost everything not included in those. And, as you correctly state, Part "C" plans are comprehensive.

RebLem's supplemental coverage ( aka Medi-Gap coverage) is something else. This is not news, of course, since I have had a UHC/AARP supplemental plan for almost 9 years. These come in a variety of choices - mine is Plan F - which pays for everything that Medicare does not: annual deductibles, co-pays, etc. However, there are no limits on providers and will pay to any provider who has accepted the Medicare assignment in the first place. Premiums, again, vary by plan. Mine, here in Connecticut, costs just over $200/month each for my wife and me (on top of $105/month each for Part "B").

The combination works perfectly, as far as I am concerned. There are no restrictions on providers and I have yet to find a doctor who will not accept Medicare. And, besides the Medicare Part "B" and the supplemental Plan "F" monthly premiums - I never have paid another penny (except for annual eye refraction exam - which Medicare does not cover).

So, for about $600/month virtually all medical costs are covered with no network or referral nonsense. One positive aspect of being over 65!

jbuck919
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Re: Medicare Advantage

Post by jbuck919 » Sat Feb 22, 2014 12:29 pm

Febnyc wrote:So, for about $600/month virtually all medical costs are covered with no network or referral nonsense. One positive aspect of being over 65!
I wonder how that compares with the cost for a "supplemental" out-of-country policy if you had decided to retire outside the US. (For those who don't know, Medicare is not portable.) :wink:

There's nothing remarkable about it. All one has to do is hit the right keys at the right time and the instrument plays itself.
-- Johann Sebastian Bach

John F
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Re: Medicare Advantage

Post by John F » Sat Feb 22, 2014 2:07 pm

If Medicare Advantage really is the same thing as "Medicare Part C," then I don't understand this talk about premiums. I pay no additional premium (beyond the government's deduction from Social Security benefits) for the additional benefits, including prescription drugs minus a small copayment. No doubt the many plans differ; mine is now called AARP MedicareComplete, but was originally branded Oxford and then SecureHorizons.
John Francis

Febnyc
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Re: Medicare Advantage

Post by Febnyc » Sat Feb 22, 2014 3:21 pm

John F wrote:If Medicare Advantage really is the same thing as "Medicare Part C," then I don't understand this talk about premiums. I pay no additional premium (beyond the government's deduction from Social Security benefits) for the additional benefits, including prescription drugs minus a small copayment. No doubt the many plans differ; mine is now called AARP MedicareComplete, but was originally branded Oxford and then SecureHorizons.
Some Medicare Advantage plan costs are satisfied by your Part "B" premium - others have an additional cost (premium). Coverages differ widely and kaleidoscopically. Some include prescription drugs without charging extra premium. Anyway, it all is very confusing.

Oxford was acquired by United Health Care in 2004. UHC is AARP's health insurance carrier.

Secure Horizons has been one of UHC's brands for their Medicare Supplement coverages. Now, under their own (AARP MedicareComplete) name, they offer three types of Part "C" plans: https://www.aarpmedicareplans.com/healt ... tage-plans

Sort of an explanation of the differences is here: http://health.usnews.com/health-news/me ... difference

University-level calculus was easier to understand. :wink:

John F
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Re: Medicare Advantage

Post by John F » Sun Feb 23, 2014 12:40 am

Thanks much for the additional information. Since my health needs are presently simple and don't cost much in co-payments, I hadn't looked into these alternatives, but it's helpful to know about them.
John Francis

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