<p>My mother was notified by her Medicare provider that her plan will no longer be available in 2014 and she needs to pick a new one. I do not understand Medicare and am having a difficult time helping her. She apparently has something that’s taken directly out of SS and previously purchased some sort of supplemental plan for less than $200 per month.<br>
There are over 30 plans on the Medicare website for her to choose from! Then I was reading that she doesn’t need to purchase anything supplemental? Can anyone explain this to me?</p>
<p>Ask her DOH Executive Office on Aging to help give you free unbiased info about her options.</p>
<p>Medicare is Medicare. She doesn’t need to purchase anything supplemental.</p>
<p>However, many people do, because Medicare can have significant out-of-pocket costs.</p>
<p>Look at the options. Decide if she wants a “Medicare Advantage” plan, which is like an HMO – she must see only network providers – usually for no or a very small additional cost.</p>
<p>She can also select a plan that has both in- and out-of-network providers. </p>
<p>Review the prescription drug portion of the plans carefully. That’s where a lot of out-of-pocket cost can go.</p>
<p>Good luck.</p>
<p>I’m in a similar place w my mom. Her former employers BCBS plan, which I have now found is secondary to Medicare has skyrocketed this year to nearly $300/month and she’s asked me to tell her what her options are. </p>
<p>The first stop was the medicare.gov website to download the Medicare & you booklet. Next, look up your state & county dept of aging. Most have resources and plans comparisons, as the supplement plans are very localized. </p>
<p>I agree that the supplement plans look interesting. (Only $51/month for my mom), however I’m going with the adage “cheap for a reason”. I’m going to spend more time this weekend, but I think when you drill down on those plans, there’s a big deductible on hospitalization coverage for the first few days that would eat up the annual savings on premium. </p>
<p>Ps - I posted a week or two ago on the same topic and surpringinly didn’t get much advice from CC.</p>
<p>I’m sorry, i didn’t see your previous post. So Medicare Advantage is the supplemental insurance and it covers doctors, hospitalization and prescriptions? Similar to a health plan that I would get from my employer? Then what’s the point of Medicare if we have to pay for a supplement to get real coverage?</p>
<p>I would not recommend Medicare Advantage. Stick with regular Medicare if you can.</p>
<p>Can you find an insurance agent to help with this? The 20% co-fees can really add up if one only has Medicare. The list of good plans include UHC/AARP, American Pioneer, USAA, Bankers, Mutual of Omaha, etc. Have a list of ALL of your mom-s medications, because each plan has their own list of what will be covered.</p>
<p>I’m not a fan of medicare HMO’s; the co-pays can be high, and the money saved on the plan is offset by co=pay. Most people who try them switch back after a year, especially if they have a chronic condition. Lots of MDs won’t accept the HMOs.</p>
<p>Keep in mind that this is true in my area, may not apply to your mom.</p>
<p>I think the best way to compared plans is to have a list of her 2012 & 2013 medical expenses and determine how they would have been treated under the various plans you are considering. </p>
<p>Why an advantage plan looks interesting for my mom is that, while she’s 85, she has no known medical conditions, takes no meds and hasn’t seen a doctor in years. She doesn’t have a primary care physician. Besides her dentist and eye doctor, the last time she was a doctor was when she fell and broke her wrist 2 years ago. All that said, she could very well be a ticking time bomb and any day suddenly need excellent insurance and the advantage plans seem to be a save-now, pay-up big later scheme, especially for hospitalizations.</p>
<p>You don’t have to buy a supplemental plan. However there is an out of pocket cost for treatment under medicare and the supplemental plans help alleviate that.</p>
<p>There are several different levels of supplemental plan. They are designated by letters (A, B, C etc). Some cover more than others and therefore cost more. Which you choose would probably depend on your general health. My husband has plan F which covers almost everything (not prescriptions as they are a different plan). We chose plan F because he has a lot of health problems. Then he got cancer and we were glad he had plan F as we paid very little out of pocket due to the combination of Medicare A, B and the supplemental plan F. (If I had been receiving the same treatment I would have paid a LOT more out of pocket with my much more expensive private insurance!!)</p>
<p>With my current level of health, I would probably choose a lower level of supplemental plan. That may change by the time I am eligible for medicare in 5 years.</p>
<p>There is a fairly good explanation of medicare here:
<a href=“http://www.medicare.gov/Pubs/pdf/02110.pdf[/url]”>http://www.medicare.gov/Pubs/pdf/02110.pdf</a></p>
<p>The supplemental plan choice always seems a lot easier to me than the medicare D decisions. We were baffled the first time we had to deal with that and had to go to a help session at the local senior citizen center. (and we are both accountants and good with numbers!). You could check and see if there are any similar help sessions in your area. We did find it very helpful</p>
<p>
Medications come under medicare D rather than the supplemental. Good advice to have all your medications available when shopping for a Med D plan though. There is a web site where you can enter all the medications and run comparisons by program to see what is covered. varies a lot.</p>
<p>VeryHappy,
Can you, please, elaborate on your “Medicare is Medicare. She doesn’t need to purchase anything supplemental.”
-My specific question is: How outpatient / drugs, anything except for inpatient is covered if you do NOT purchase anything supplemental. Plan A (NO purchase of anything supplemental) covers only hospital. Is it realistic to assume that person will either never require outpatient care or is willing to pay cash for services outside of inpatient care?</p>
<p>Swimcat,</p>
<p>Nicely done, your explanation. </p>
<p>Just as an example, Abilify costs $800/month, but some plans cover most of it, others don’t. Same with many of the newer, non-generic meds. The cost of pain meds and CA meds are SO high.</p>
<p>I have to spend time on this topic this weekend too. My mom is under our states university retirement system (survivors) plan. Their plan was second to Medicare so this year, when she was hospitalized for 3 days, all the bills - doctors, hospital, etc. - went through medicare, then cigna (the surs plan). She had to pay a total of 50 dollars after all was said and done.
Now the state sytem is replacing cigna with medicare advantage. Her choices are a Medicare Advantage HMO plan, and a Medicare Advantage PPO plan (UnitedHealthcare). It sounds like if she wants to keep her “university” benefits, she has to give up regular medicare and go onto one of their Medicare Advantage plans. I get stressed out just thinking about it. She has been very healthy since March and just takes blood pressure and cholesterol drugs. I’m wondering if I should just read what I can, pick one, and let it go - because at least each year gives us a new opportunity to pick again.</p>
<p>I also need to gen on the exchanges for our family, but that is another, separate headache.</p>
<p>
Prescriptions are a completely separate plan and come under Medicare D. It is a completely separate plan to Medicare A and B. (drugs in hospital are covered under Medicare A/B I think and also I believe chemo drugs are). </p>
<p>The supplemental plans do not cover prescriptions. They are supplemental for treatment, doctor visits etc. </p>
<p>So basically you have Medicare A, medicare B, supplemental plans of varying levels (I think you have to have A & B to be eligible), and then Medicare D for prescriptions.</p>
<p>For instance, my husband has Med A, Med B, a supplemental plan with level F (covers most everything), and he has medicare D for prescriptions (we spent far, and I mean FAR, more out of pocket on prescriptions than on all his cancer treatment - Medicare D is horrid if you have a lot of prescriptions).</p>
<p>What sort of costs is everyone seeing for supplement & part D? (Part B comes out of SSI, so I assume that’s the same nationwide). </p>
<p>My moms employer will charge $225/month for their plan, which includes a prescription plan that’s better than part D. She’s inclined to stick with it, as it’s good coverage and they had very little out of pocket when my dad was alive and had major medical problems.</p>
<p>My husband thinks his supplemental F is around $180. Not exactly sure as the company he retired from pays a subsidy toward it of around $90 and we pay the difference.</p>
<p>His actual Med D premiums are not high, but he is on enough meds that he hits the donut hole every year. This year and last year we hit it in january and were through to the other side by Feb! (that means we had spent over $4700 out of pocket). Thank goodness they were finally able to take him off the one medication.</p>
<p>If your Mom has a plan that has good prescription coverage, I would stick with it. Medicare D is awful (and complicated -I have read all the rules over and over and have never yet been able to correctly anticipate what something will cost. And I’m pretty much a numbers person! Drove me nuts not being able to figure it out so I gave up trying)</p>
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<p>Not true. Many do.</p>
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<p>People with high incomes pay more for Part B coverage.</p>
<p>There are some Medicare Advantage plans that cover everything but have no additional cost beyond basic Medicare. Usually the providers are limited – like an HMO – but the coverage can be very good. I just signed up for a Medicare Advantage plan starting January 1. Seems to be very comprehensive coverage, all my docs are in the network, and it also has reasonable prescription drug coverage.</p>
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No. Supplemental plans are not allowed to.</p>
<p>VeryHappy - I think we are talking at cross purposes here. I am talking about supplemental policies, not medicare advantage plans. They are completely different things. Supplemental medigap plans are not allowed to include prescription coverage. I believe some used to, but they have not been allowed to since 2006 (when Medicare D was introduced I believe). If I am wrong, I would love to be directed toward one of these plans because my husband could sure use one.</p>
<p>My understanding (admittedly limited) of Medicare Advantage plans is that they are private plans that replace Medicare A, B, and yes, often include prescriptions (some sort of contracting out with the govt). They are not the supplemental plans I am talking about. The supplemental plans supplement A and B rather than replace it, and do not include prescriptions (and also are not available to those with medicare advantage plans).</p>
<p>I must admit I don’t know much about how the medicare advantage plans work. I am sure we must have investigated them when my husband first went on medicare but I have slept since then. Presumably they must not have been advantageous for him but it sounds like you have found a good plan. Maybe we should have another look, though what we have seems to have worked very well for him (other than the prescription costs) over the past 2 years with his cancer treatments (we traveled out of state to a major medical center for his treatments as his cancer is a hard to treat one) and I would be a little scared to rock the boat at this point!</p>
<p>swimcatsmom, you’re right. I was equating Medicare Advantage with Medicare supplement plans, because when I went on Medicare.gov and look for supp plans in my state, they show both types.</p>
<p>Once upon a time I would have steered clear of the Medicare Advantage plan because of the in-network-only component. However. all my docs and other providers are in-network, and if anything really significant happens, a nearby teaching hospital/medical school is in-network as well.</p>
<p>I’m sure we must have looked at the time, so I imagine maybe our doctor wasn’t in it or maybe our small town was not well covered (we are over 100 miles away from the nearest big city and the only way I would set foot in our local hospital for anything major is if I would be dead before they could get me to the next nearest one). Or maybe as he already had a lot of major health issues even before the cancer, the original medicare was a safer bet at the time. </p>
<p>I will certainly look into the Medicare advantage when I get to medicare age (and especially if I can persuade my husband to move to a bigger city - I’m working on it!).</p>