OT: Medicare Advantage

[Rickv]

You should also look at Medigap plans. I recently signed up for plan G after you meet the $185 annual deductible it covers whatever medicare doesn't with no copays. It goes into effect on Jan. 1st and will cost me $177 a month plus another $72 for prescription coverage. Another reason is that we travel out of state a lot with our RV and Advantage plans don't cover out of state where as the Medigap covers the whole country.

[Janknitz]

I second the suggestion to talk to your state's SHIP or HICAP (California) program. It's FREE, unbiased counseling about Medicare supplemental and advantage plans. Their number is on the back of your Medicare and You booklet you get every year, or you can find it on the www.medicare.gov website.

There are a few things to understand about Advantage plans.

1. You MUST use their providers. An advantage plan becomes your Medicare provider and there is NO coverage for out of network providers, DME, labs, X-rays, etc unless you have authorization beforehand and it's very unlikely to get such authorization. If it's a self-contained advantage plan like Kaiser or Humana, you cannot go out of network period (with some very rare exceptions). So you need to make sure you are going to be willing to use their providers and you have to make sure you have ample choice of providers in your area who REALLY take other kinds of Advantage plans. Some of these Advantage plans pay providers so little that you cannot find willing providers in your area, even if they are listed as taking that plan--call around and confirm that they will take new patients with that Advantage plan before you switch. That's not a problem with self-contained advantage plans like Kaiser, but if you travel out of the area, you may find there are no providers. I attend a conference about 200 miles away every year and twice I really needed urgent care, but there was no Kaiser facility nearby. Yes, they will pay for you to go elsewhere in an emergency, but it wasn't quite to the level of an emergency and I know how big the fight is to ever get them to pay.

An added issue with self-contained Advantage plans is that they have protocols for things and if you don't fit into their little box you may be out of luck. My biggest fear with Kaiser is an unusual cancer--they have their standard treatments and you're out of luck if there's a newer better protocol they don't use--a friend is going through that now but fortunately she does not have Kaiser. We also have to travel for services, and complicated surgeries or illnesses can only be managed at distant facilities, which makes it hard for you to have family and friends support recovery. That's not always the case, but it depends on where you live.

2. Be aware that once you have switched to an Advantage plan you may NOT be able to ever get a supplemental (medi-gap) plan again, even in open enrollment. That may depend on state law, so your local SHIP or HICAP can advise you about that.

3. Advantage plans (really any drug plan nowadays) have limited formularies, so you may find that the medications that do best for you are not available on their formulary. You should check that out before ever switching your insurance, and those of you on traditional Medicare Part D plans should look at your plan every year during open enrollment to make sure they STILL cover your meds without exorbitant co-pays.

4. As Pugsy pointed out, you will probably be stuck with perpetual pay on your CPAP machine, so run the out of pocket costs and consider buying your own machine. You can still get supplies covered.

I know this is kind of negative, but my husband is on Kaiser Senior Advantage and for him it's relatively a good thing. He is pretty healthy overall, and pays only $20 a month over his monthly Medicare premium, he gets vision care, help toward buying hearing aids and a free gym membership. So for him it works well (pray that he continues in such good health).

[atab]

Didn't notice this wonderfully descriptive posting earlier. Thank you, Janknitz.

Atab