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I need some overview - big picture of the medicare system. My mother is 83 and has been for several years paying for an Independent Health insurance coverage - it was plan called Advantage PPO. Now, they informed her that monthly coverage was going from $100 to $160 month. So, she went to one of these free information meetings put on by the insurance company and a representative told her that she did not need to pay any monthly premium. So she signed up for a policy that has $0 dollars monthly premiums. Hospital stays have a $700 deductible (max 3 ?). This does not sound logical. Some other items that I am confused on are listed below -

I need a big picture - all the internet stuff talks details that is getting me all wrapped around the axial.

Here are some of the items I am confused on:

1. I understand that Medicare has parts A, B, C, D. Everyone is in part A and part B costs about $100 / month that is automatically deducted from the SS given to her. How does she know that she is covered by Medicare B ? Where does it show that the Gov takes the $100/month for Medicare B ? She worked a little in her life, but is under my fathers SS coverage.

2. Medigap coverage - I see the Gov has "plans" for Medigap coverage that are called Plan A, Plan B, etc... How come Independent Health calls the insurance she has been getting "Advantage PPO" ? What about Plan A, Plan B, etc... What is this, the Insurance companies do not call the policy they offer the same name as the Gov. plans ? OR has my mother NOT been getting Medigap but some other policy coverage ?

3. As I stated in the beginning - my mother was paying $100 / month that is going to $160 month in 2013. Now the insurance company has signed her up for $0 / month starting in 2013. I have never seen any company give something for FREE. Never ! McDonalds wants $0.10 for extra ketchup packets, Dunkin Donuts does not even give napkins when U buy a doughnut ! Why is the insurance company providing "coverage" for $0 / month ? What is the gimmick here ?

4. Can she change back to the other coverage plan next open enrollment period in 2013 for 2014 ? Or is she locked into this $0 / month plan ?

Thanks for any advice !

math999man
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There are two broad sides of Medicare -- the Advantage Plans and traditional Medicare. You pick one or the other. At this point I do not know if you can switch or how to do that. To find out if you can switch, start by calling Medicare. If you have not established legal authority with Medicare to act for your mother, she will have to be on the phone and answer questions before you can get any patient specific information. (As an aside to obtain authority to act on behalf of your mother, I expect a physician will have to say your mother can't do it - the usual reason is something like diminished capacity - which can be mental or physical as in a stroke victim. We have such authority for a friend. It is possible as a son you will not need the authority, but get it you can. Note: A Power of Attorney specifically will not be recognized by Medicare.)

The Medicare care Plan A, B, etc. you mention are private insurance plans which cover things not covered by Medicare. The cost of these varies with age, the plan chosen and to some extent the insurance company.

I am very biased against Advantage Plans - currently they do offer the lowest out of pocket costs. But that is because currently Traditional Medicare is paying a capitation to all Advantage plans. This capitation rate is the roughly $718 billion that was called a Medicare Plan cut or whatever during the recent election fight. The capitation was a part of the Advantage plans because when passed under President Bush these plans were not financially viable - i.e. no insurance company would offer an Advantage plan without the capitation.

My bias is very simply based - there used to be HMO plans back in the 90s. These eventually all went bust. The Advantage plans are really HMO type plans with a different name. If the capitations are reduced or cut, the only options for the insurance companies will be ration care, raise premiums, restrict physician choices, etc. Just what the HMOs did in the 90s before they threw in the towels.

The no charge Advantage plans, as I understand it -- I am not very knowledgeable will have copays and deductibles. My guess in your previous $100/month plan had none of minimal ones. (In either case if you go beyond generic drugs expect to pay something.) The reason the plans currently cost consumers nothing is a combination of two payments to the insurance companies. The Capitation I have mentioned and another transfer which as I understand it is the Medicare Part A average cost or premium.

Gordon
Atlanta
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Yes, the Medicare Advantage plans available in my area offer full coverage including medications for no charge other than the Medicare premium paid to the govt usually by deduction from your Social Security payment.

The catch is these are PPO plans. You pay copays on just about everything and you must go to an in network doctor or hospital to get the best rate. Copays can become prohibitive if you go out of network. In my area, the best regarded hospitals do not participate. So you must go to a second or third tier hospital or pay extra.

I worry that a major medical event with extended hospitalization could cost you thousands in copays.

AARP/United Health Care is one of the major promoters of this plan.

Medicare supplemental insurance (Pt B) gives you more choices at somewhat higher costs.

Medicare has an enrollment period every fall. During that period you can change insurers if you wish. I believe the end of that period is in the next few days. Call Medicare or check their website to be sure.
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The enrollment period for Part-D ends December 7th. I have no idea if Medicare has the same date or not. Since coverage actually changes on January 1st, the end of the change period if not past is imminent.

Gordon
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We've been undecided about whether to leave the Blue Shield of CA group PPO coverage my wife kept when she retired from San Mateo County in CA and get level F Part-D coverage. Coverage for my wife and I (73 & 76) costs about $1000 a month, and combined with Medicare seems to cover just about everything except dental and routine eye exams. To complicate the decision, I had a pituitary adenoma resection in 1987 that resulted in hypopituitarism. An endocrinologist tires to keep my labs within normal range so prescribes quite a few drugs, the cost of which would be about $1000 a month if we paid more than the small copay. When I've checked into it before, it seems very complicated because of the drug formularies. I'm unsure whether Part-B of Medicare ( which we signed up for) or Blue Shield pays for that medicine.

db
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I'm unsure whether Part-B of Medicare ( which we signed up for) or Blue Shield pays for that medicine.

Part B pays nothing for prescriptions. That's Part D, which may be what your BCBS includes.

Phil
Rule Your Retirement Home Fool
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Well you waited to long this year. But next year when enrollment opens go to Medicare.gov and use their online tool to compare Part-D plans. You can enter your drugs and see which plans have the lowest total cost. In your case the premium difference between a $40 a month and $25 a month plan probably is not a major factor -- but the premiums, co-pays and deductibles are all considered. The tool knows which drugs for each plan are in which cost Tier.

A word of warning - do not try and use the until the official enrollment period begins. Some plans will have full data early, some no date early others will have partial data, last years price, or even list pricing.

Finally, another reason to use this is the system will remember your drugs so you can come back in the fall of 2014 and will only have to add the new drugs and delete those you no longer take.

Gordon
Atlanta
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Thanks, Gordon. I've bookmarked medicare.gov and it should be useful to help us select a plan or decide to stay with what we've got.

Social Security deducts $104.90 a month from each of our benefits for medical insurance. San Mateo County deducts 979.97 a month for Medicare PPO coverage with Blue Shield of CA from my wife's COLA pension. That totals to 1189.77 a month. I wonder if we may have overlapping coverage for medicine.

db
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It may be that without knowing it you have "selected" that PPO. That cost even by CA standards seem high to me. Are you sure it is only the Medicare PPO and not including coverage for you or something else? You can still call medicare on Monday and find out what is going on. Who knows, maybe an error has happened and if nobody asks the computers will just keep on deducting money.

Gordon
Atlanta
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wow...you're being taken for a ride....

you must have duplicate coverage.


Most 'supplement policies' are $120-150 a month..in addition to your $104 payment to the gov't for Medicare....



t.
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Gordon,

I should have been explicit that the Blue Shield PPO covers both my wife and me.

db
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Well in that case the cost you have is reasonable. AARP supplement for plan C are in the range of $200 a month. Contrary to what most people believe the Medicare fees & premiums seniors pay cover less than a quarter of the total cost - and in the case of a Plan C medigap plan that covers 20% of the actual costs plus of course overhead and insurance company profit.

While nobody likes the cost, I do not see long lines of people hoping for second tier medical care which is less expensive.

Gordon
Atlanta
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We've been undecided about whether to leave the Blue Shield of CA group PPO coverage my wife kept when she retired from San Mateo County in CA and get level F Part-D coverage. Coverage for my wife and I (73 & 76) costs about $1000 a month

At my husband's exit interview with the retirement benefits person, I asked what happens if he left the employer retiree health plan--could we rejoin at a later date. They said Yes. So if you find a better deal next year or whenever, but turn out to prefer your wife's County insurance after all, you could probably go back, too, at the regular annual signup time. Do check on that before you change anything.

Ours is also a BC PPO plan, but this being South Carolina, it costs $272 for the two of us. Then again, he was paid SC wages...your insurance is more than his pension ;-)
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Most 'supplement policies' are $120-150 a month..

Not true, it depends on your age and your geographic location. My wife and I live in Mendocino county, CA. We our 72 and 74 both with Plan F with Mutual of Omaha and will pay $221 and $233 next year.
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We too have Mutual of Omaha supplement. Our ages are 68. We are currently paying $139/mo ea. and we live in Arkansas.
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"Not true, it depends on your age and your geographic location. My wife and I live in Mendocino county, CA. We our 72 and 74 both with Plan F with Mutual of Omaha and will pay $221 and $233 next year. "


Mutual of Omaha jacket up rates across the board by over 20%.


I switched to another provider.

I hit the 'high income' bracket a year ago....so they whacked me for that too in my basic Medicare coverage...... Buffet bought out my Lubrizol stock.....made a nice gain....but of course, that drove my AGI too high.....

this year will be 'normal' and next year my Medicare payment will drop in half.....

Supplement switch saved me 25 bucks a month.


t.
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"We too have Mutual of Omaha supplement. Our ages are 68. We are currently paying $139/mo ea. and we live in Arkansas. "

Mutual of Omaha had a 27 buck a month increase from $123 to $150/mo in the Dallas suburbs. I told them to take a hike. I'm 66. Got the same coverage from another A rated provider for $125 /month.


t.
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Mutual of Omaha jacket up rates across the board by over 20%.

Sounds like a shoot from your hip statement. Again, not true. My increase in January will be 1.8% and my wife will have an increase of 3.9%.
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"Mutual of Omaha jacket up rates across the board by over 20%."

According to my agent....M of O jacked up all the local policies by 20%....... and others around the country had complained about their big increases this year.


I guess they got you last year...



t.
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telegraph mentioned A rated provider. Where do you find such ratings?

db
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telegraph mentioned A rated provider. Where do you find such ratings?

Medicare.gov
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According to my agent....M of O jacked up all the local policies by 20%....... and others around the country had complained about their big increases this year.


I guess they got you last year...



Your right there was a larger increase last year. Actually, my wife and I had 2 increases. One effective 1/1/12 for 4% and 3.8% respectively and another effective 6/1/12 both for 11%. These 2 increases equate to a combined increase of approximately 15%.
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TwoCybers: <<Note: A Power of Attorney specifically will not be recognized by Medicare.)>>

My late mother had a General Durable Power of Attorney, naming me, her only child, as the Attorney-in-Fact. Medicare and Social Security did recognize this.

Donna
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Paulecker: <<Medicare supplemental insurance (Pt B) gives you more choices at somewhat higher costs.>>

Part B is the part which covers doctors, etc. and which premium is deducted from the SS check. The Medicare Supplement Insurance is commonly known as "Medigap", and is totally separate from Medicare, and is paid personally, not through the SS deduction. See: http://www.medicare.gov/supplement-other-insurance/index.htm...

Donna
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