OT: Medicare Advantage

It is time to reevaluate Medicare Advantage plans again.
Has anyone used Humana Gold Plus? An agent recommended it to me.
Any feed back, pro or con would help.

The companies have spent a lot of money to promote "advantage" plans.
Why do you suppose that is? Agents may be earning commissions.
Obviously, they expect to make back their investment--and then some.
Go ahead and believe their agent, but I'm not that gullible.
Edit, I just read a comment on yelp. They are evil.

My preference is straight medicare with a medigap policy. I worked fielding calls in a group practice that was in an HMO type of coverage. The good doctors were full and woe to those who were assigined a doctor who wouldn't refer or do the paperwork on denials. I want to be able to choose my doctors and have a say on testing, and hospitals. Needless to say I didn't stay long in that job. It all comes down to what you can afford but I don't want to pay an insurance company to make decisions for me, because that's to their advantage.

The advantage plans depend on which state and county you live in. While Cigna Healthspring has been operating in Georgia for years, it won't be starting in my county until January 1, 2015. This plan puts all the other plans in my area to shame and is the one I have opted to use. With that said, it may be out done the following year. This seems to be a subject that a person has to constantly follow. Good Luck!

I am very well aware that "sometimes " you have to fight for what you want with the advantage plans.
I am still relatively healthy,except for my Apnea and afib.
I am to cheap to pay for a medigap plan or the deductables and copays of straight Medicare.
So my choice comes down to the least offensive best fit Advantage plan.
Hence the question any feedback on Humana Gold Plus?

Stay healthy. I know my family history, and figure the supplement is making a profit on me now,
but I can't afford to gamble with the future--and when you change coverage, you can never go up.

I have the AARP medical advantage thru United Healthcare. We have had it for 5 years with absolutely no problems. Each state has different plans. Check the back of your Medicare 2015 book for plans in your area.

bwexler wrote:I am very well aware that "sometimes " you have to fight for what you want with the advantage plans.
I am still relatively healthy,except for my Apnea and afib.
I am to cheap to pay for a medigap plan or the deductables and copays of straight Medicare.
So my choice comes down to the least offensive best fit Advantage plan.
Hence the question any feedback on Humana Gold Plus?

My sister-in-law has the Humana Advantage plan that is the HMO. She has hit a few bumps in the road, like not being able to visit the Immediate Care Center unless she gets a referral from her PCP, which requires a visit to the PCP. Well, if you can get an appointment with your PCP you wouldn't need the Immediate Care Center!!! If you are willing to live with a few stupid issues like this, then the plan does save money. I personally would not get an Advantage plan unless I was in the category that both my sister-in-law & brother in-law both are - under 65 & unable to get a Medical policy.

If I were considering the Advantage plan seriously, I would look for the PPO plans, they give you more freedom & flexibility. I just signed my brother-in-law up for the PPO version of Humana. I chose that for him due to both flexibility & that plan's coverage for his oxygen.

I would suggest that you make a list of what you think you will need, then match that list against the coverage, as listed on the medicare.gov website. I would then check the Humana website to make sure there are no differences. If you find any, call Humana rep to clarify. Then get that clarification in writing.

This is my approach to any insurance issues during open enrollment. They can say anything on the phone, but if you get something in writing, its harder for the insurance company to deny if you have an issue during the coverage period. This is still not iron-clad, but still gives you a little more security than just 'well the rep said'...

Good luck with whichever plan you choose.

Jen

So far I have the independent brokers strong recommendation, the brochure package outlining all the benefits and the evidence of insurance book. Now I need to read the whole thing. I agree that the PPO is a better option, but much harder to find with no monthly premium. So for me the best fit among poor choices is the HMO Advantage Plan. Now it's just a matter of picking the least offensive that provides the most benefits within my scope of needs. And then make sure it fits my wife too.
The biggest hesitation now is the 3 star rating. Which is why I am here. The warning about the catch 22 above is exactly the kind of information I am looking for.

I can't speak about Humana experiences, but can give you my $.02. I think the best you can do is investigate and compare as you are doing. It seems that the plans and the execution are very state specific and what might be great in one state isn't so great in another. Here in Hawaii, the BCBS PPO plan I chose last year is excellent. Not one hiccup in the year I've had it. (The DME is another story, but also not too bad.) My plan was discontinued for next year, and I seriously considered Humana Gold (here they are rated 4 stars), but I could not convince myself that HMO was the way to go. And if I did, I'd probably go Kaiser Permanente who consistently gets the highest ratings here and family members have had experience with. Paying a small amount monthly might be worth it to go PPO if you can. All the stories of bad docs scared me into staying PPO and I can see a specialist of my choice without a referral. I'm sure you've considered the balance of max out of pocket, drug plan co-pays, formulary, etc., in your musings, and that's the best you can do. One thing I'd suggest is to call the number listed for the plan and get specifics about co-pays on CPAP supplies, specifically by the HCPCS codes for the specific DME. They should be able to give you this information, but you may have to fight for it. (For example, for my machine it's 3 months of $10 followed by 10 months of $7 for the rental. My $2500 sleep study was a $25 copay. Supplies range from $1 for 2 filters to $13 and change for a new mask.)

The main turnoffs for me would be the inability to select my doctor and choose a specialist if I wished, as well as choice in DME's and the equipment they provide. Your criteria may well be different, and so YMMV. It's a really difficult decision. But I finally signed up for another PPO plan still in the BCBS family, and just got my packet in the mail for next year.

Good luck with it. And next year you can change your mind if it's the wrong decision this year.

After reading all the posts, I'm feeling very fortunate. My primary, cardiologist, gastroenterologist, pulmonologist, ophthalmologist, and drugs are all on the advantage plan I've chosen at the cost of the part B only. The only one not on it is my dentist . . .of course he isn't on any insurance plan. You all make me feel better.

If you pick Humana HMO Medical Advantage Plan. You will have to deal with Apria as your DME. For sure here in Texas you do.

I have Humana Gold Plus. They have been wonderful especially when it comes to dealing with DME's.
They have a patient advocate who helps navigate you through the medical syatem. Straight 20% copays on cpap supplies and machine rentals. My Dr switched me from Cpap to Bilevel due to having COPD. I thought for sure they would at least require another sleep study since my last one was about 18 months ago and the machine was $1800!
The Dr ordered the machine from local DME on Friday. They called me on Monday to come in and pick it up no problem. That has been my experience with Humana

I live in Kentucky and my DME is Medsource. We dont even have Apria here

I have a Humana Medicare Advantage Plan -- Humana Gold Choice (PFFS). On my particular plan, DME coverage is the same in or out of network so I can choose my own DME. I hate to jinx it, but I've had almost no issues with this plan. All my current doctors take it and I make a small copay ($15 or $40) and occasionally get another small bill for other things, but never significant. This plan also has part D coverage and all but one of my prescriptions (I take a LOT) are covered 100% (I have no copay on them).

I live in Virginia.