Vision insurance.

[DanZemke]

1 hour ago, Kirk W said:

That is a question that I have had for a long time. Can you explain it or do you know anyone who cah?  I haven't checked recently, but our primary care doctor used to not accept Advantage plans.

Your doctor probably refuses to accept Medicare Advantage plans because they often pay less than Medicare does and are are more difficult to work with than Medicare.  

I used to have a Medicare Supplement, but was forced, by my ex-employer, to move to a Medicare Advantage plan with United Health Care (UHC). There are many positives about this plan, but I've found UHC's bureaucracy to be extremely frustrating. I wasted dozens of hours of my time, last year, dealing with them.

[GlennWest]

Is ehealth website good place to compare plans. Was on there and had option to choose my doctor/ vision centers, hospital. All stated no. That don't look promising

Edited July 22 by GlennWest

[Blues]

13 hours ago, GlennWest said:

My wife has plan F and it is good coverage. She pays very little at visits. It has gone up right much also. I was not offered F when I got mine. N was all I was offered.

If she has a Plan F supplement, she shouldn't be paying anything.  And the premium for it is going up because the only people who can have Plan F are those who were eligible for Medicare before 2020.  The participants in Plan F are aging, and younger people aren't being added to the pool to offset the older people's increasing medical bills.

Plan F has been replaced by Plan G.  The only difference is that under Plan F, the supplement pays your $240 deductible, while under Plan G, you have to pay that yourself.  However, Plan G generally has lower premiums than Plan F, and in a lot of cases it's actually cheaper to pay your own deductible because the difference in the yearly premium between Plan F and Plan G is more than $240.

Your wife should check into switching, but in most states people have to undergo medical underwriting in order to change supplements.  At some point the only people left on Plan F will be very old people who are too sick to pass medical underwriting to switch plans, or who don't realize what's going on with Plan F.  If she can get out of Plan F, she should. 

I'm not sure why you were offered only Plan N.  Plan N is often recommended for people who are healthy, but I've never heard of anyone not being offered Plan G (assuming they're being offered supplements at all; way too often all that gets pitched is Advantage plans).  What gets covered by Plan G and Plan N is the same (except for "excess charges" coverage, which is kind of esoteric), but the way you pay for it is different.  Plan G pays everything for you once you meet your $240 deductible, while Plan N has you paying copays for doctor visits and emergency room visits, and those copays don't get credited against your deductible.

My usual advice is that if you can afford it, get traditional Medicare with a Plan G supplement, and a Part D prescription drug plan even if you don't take any drugs (to avoid a lifetime penalty if you want a Part D prescription drug plan in the future).  Pay for vision and hearing and dental care out of your own pocket. 

If you want to save some money, then depending on your health, consider traditional Medicare with a Plan G high-deductible supplement or a Plan N supplement instead of Plan G (with of course a Part D prescription drug plan).

If paying for traditional Medicare and a supplement is going to put a crimp in your style, then your only choice is an Advantage plan.  But there is a dizzying array of Advantage plans, and I'm thankful I haven't had to wade through them; comparing ACA plans was bad enough.  One thing I'm gathering is that cancer treatment with an Advantage plan can be very expensive, and will likely make someone hit their out-of-pocket maximum due to the cost-sharing Advantage members have to pay, so the out-of-pocket maximum should receive attention when shopping.

(I have a friend who's very rich and her husband somehow enrolled in an Advantage plan and got cancer.  He's been being treated for it for several years now, and he hits his out-of-pocket maximum every year.  His Advantage plan is costing him more every year than traditional Medicare and a supplement would.)

I hate that all knowledge is now found only in youtube videos, but here's a pretty good one about cancer coverage:

https://www.youtube.com/watch?v=77YF-TL0n-8

This guy is generally pretty informative, so you might want to look at some of his other ones.

Quote

Sooner or later I will need good coverage. Is there any Advantage plan as good as what I have.

It depends on how you define "good." If you're looking only at medical care covered by Medicare, no Advantage plans offer coverage as good as traditional Medicare because one way Advantage plans keep costs down is by requiring members to see only network providers, and something that's not emphasized enough--they can require members to get pre-approval for certain procedures.  They can dictate the type of treatment you receive, even if your doctor recommends something else. 

So for the most comprehensive medical care, it's traditional Medicare plus a supplement, hands down.  But if the extras like dental and vision benefits are a factor, it becomes necessary to weigh that against possibly compromised medical care. 

 

[Dutch_12078]

7 hours ago, Blues said:

If she has a Plan F supplement, she shouldn't be paying anything.  And the premium for it is going up because the only people who can have Plan F are those who were eligible for Medicare before 2020.  The participants in Plan F are aging, and younger people aren't being added to the pool to offset the older people's increasing medical bills.

Plan F has been replaced by Plan G.  The only difference is that under Plan F, the supplement pays your $240 deductible, while under Plan G, you have to pay that yourself.  However, Plan G generally has lower premiums than Plan F, and in a lot of cases it's actually cheaper to pay your own deductible because the difference in the yearly premium between Plan F and Plan G is more than $240.

Your wife should check into switching, but in most states people have to undergo medical underwriting in order to change supplements.  At some point the only people left on Plan F will be very old people who are too sick to pass medical underwriting to switch plans, or who don't realize what's going on with Plan F.  If she can get out of Plan F, she should. 

I'm not sure why you were offered only Plan N.  Plan N is often recommended for people who are healthy, but I've never heard of anyone not being offered Plan G (assuming they're being offered supplements at all; way too often all that gets pitched is Advantage plans).  What gets covered by Plan G and Plan N is the same (except for "excess charges" coverage, which is kind of esoteric), but the way you pay for it is different.  Plan G pays everything for you once you meet your $240 deductible, while Plan N has you paying copays for doctor visits and emergency room visits, and those copays don't get credited against your deductible.

My usual advice is that if you can afford it, get traditional Medicare with a Plan G supplement, and a Part D prescription drug plan even if you don't take any drugs (to avoid a lifetime penalty if you want a Part D prescription drug plan in the future).  Pay for vision and hearing and dental care out of your own pocket. 

If you want to save some money, then depending on your health, consider traditional Medicare with a Plan G high-deductible supplement or a Plan N supplement instead of Plan G (with of course a Part D prescription drug plan).

If paying for traditional Medicare and a supplement is going to put a crimp in your style, then your only choice is an Advantage plan.  But there is a dizzying array of Advantage plans, and I'm thankful I haven't had to wade through them; comparing ACA plans was bad enough.  One thing I'm gathering is that cancer treatment with an Advantage plan can be very expensive, and will likely make someone hit their out-of-pocket maximum due to the cost-sharing Advantage members have to pay, so the out-of-pocket maximum should receive attention when shopping.

(I have a friend who's very rich and her husband somehow enrolled in an Advantage plan and got cancer.  He's been being treated for it for several years now, and he hits his out-of-pocket maximum every year.  His Advantage plan is costing him more every year than traditional Medicare and a supplement would.)

I hate that all knowledge is now found only in youtube videos, but here's a pretty good one about cancer coverage:

https://www.youtube.com/watch?v=77YF-TL0n-8

This guy is generally pretty informative, so you might want to look at some of his other ones.

It depends on how you define "good." If you're looking only at medical care covered by Medicare, no Advantage plans offer coverage as good as traditional Medicare because one way Advantage plans keep costs down is by requiring members to see only network providers, and something that's not emphasized enough--they can require members to get pre-approval for certain procedures.  They can dictate the type of treatment you receive, even if your doctor recommends something else. 

So for the most comprehensive medical care, it's traditional Medicare plus a supplement, hands down.  But if the extras like dental and vision benefits are a factor, it becomes necessary to weigh that against possibly compromised medical care. 

 

This what my UHC Advantage Plan says about the out of pocket maximum (emphasis added):

"Annual out-of-pocket maximum"

"This is the most you pay for covered services from network providers during the year."

"Your deductible, copays and coinsurance for covered network services count toward this amount. After you reach your out-of-pocket maximum, the plan will pay 100% of your costs for the rest of the year."

When my wife was being treated for her cancer including surgery, when she hit the out of pocket maximum, she never saw another bill.

Regarding coverage, Advantage Plans are required to cover everything that Medicare covers, and we can see non-network doctors at any time by paying a slightly higher co-pay.

Edited July 23 by Dutch_12078

[GlennWest]

Oh, not getting Advantage plan. Was very eye opening checking hospitals doctors ,etc. We will be in a very rual area. Small town nearby. Nothing local was in it's network. I would be having to drive long ways for any coverage. Longest search I could do on site was 50 miles and only a PPO one had just one hospital in coverage and it about 40 miles away. They didn't offer G and I didn't know to question them. Really was working a 7/12 work week while doing this. Also I take no meds. No bp problems. No clostridial problems. Non smoker for 35 years. Weight good. 

Edited July 23 by GlennWest

[Blues]

9 hours ago, GlennWest said:

They didn't offer G and I didn't know to question them.

You said your Plan N supplement is from Mutual of Omaha.  Who did you go to to buy it?

Edited July 23 by Blues

[GlennWest]

Called mutual of Ohmaha

[GlennWest]

I haven't had any problems with it. After deductible it pays all but my co pay. Know it doesn't cover any overage but that has not been a problem. But all I have used is for is ingrown toe nails and a physical 

[Blues]

You're a good candidate for a Plan N supplement.  You'll save money as long as you continue not going to the doctor.  As I'm sure you're aware, copays in a Plan N supplement for doctor and emergency room visits do not go toward satisfying the Part B deductible, but at $20 a pop and only a $240 deductible, it's not a big deal if you don't go to the doctor often.

Of course you have no idea whether you'll be needing a lot of medical care in the future, such that the Plan N supplement is no longer saving you money because of frequent copays.  That's what's maddening about all of this--we're expected to make decisions based on what might happen in the future.  It's bad enough with supplements/Advantage plans, and prescription drug plans are even worse.  Basing the choice of a plan on the drugs you're currently taking is insane.  But that's the system we have.

Like you, I don't take any drugs, so I got the cheapest Part D prescription drug plan available.  But I have absolutely zero idea about how (and even whether) it will cover any drugs I might be prescribed, so I have a lot of exposure there (that I can't do anything about).  I chose a Plan G supplement because I would save money on a Plan N or a high-deductible G, but the difference in cost is not going to affect my lifestyle, so I'm choosing the easiest one, with known exposure--just my premiums and my $240 deductible. 

I will caution you about Mutual of Omaha.  Did you see upthread where I talked about Plan F premiums increasing because everybody with Plan F is getting older and costing the insurance company more money, and younger people aren't being added to the pool to balance that out?  Supplement insurance companies can do the same thing--the people who already have the plan can keep it, but the plan is not available to new people.  It's called "closing the book" and Mutual of Omaha is one of the companies that is often cited as engaging in this practice.

They close one supplement (e.g. a Plan G), and start another Plan G supplement under a different company name.  That new supplement will have low premiums because most people signing up for it will be young and won't be incurring big medical bills that the insurance company has to pay for.  They'll keep that plan open for a few years, and then close it and start over again.  That way they can keep their premiums for people who are turning 65 attractively low.

It's hard to find out who does this and how often because if a plan is closed, you don't see it on any quoting sites and agents won't mention it because you can't buy it.  And since they change the name of the company, it can be hard to track even if you have access to information about all the supplements out there, including the ones you can't get.

Mutual of Omaha is not the only company that does this, but it's the most notorious.  When it happens, if you're in a state that doesn't allow people to switch supplements without underwriting, if you can't pass underwriting for another supplement, your only options are to pay the ever increasing premiums for a supplement you're trapped in or switch to an Advantage plan.

So you might consider, while you're healthy, switching to another company.  All supplements of a given plan letter cover exactly the same thing, and they have no say in what gets paid; if Medicare pays, the supplement pays.  So it doesn't matter which company you have when it comes to paying the bills on your behalf.  People will often say, "I'm happy with my supplement company" without understanding there's nothing to be unhappy about. 

The only difference with a different company for the same plan letter supplement will be the premium.  But not just the current premium, but the future increases, which of course we (and even the insurance companies) can't predict.  But you can avoid companies that are known to engage in the completely legal practice of closing a book of business and opening a different one with low premiums that are attractive to people who are turning 65 and imposing big premium increases on people trapped in previous plans (premiums are based in part on claims experience).

Also, for what it's worth, Medicare doesn't pay for annual physicals.  They do pay for an annual "wellness visit," but that's not a hands-on exam; it's just a discussion about your health and risk factors, often mainly with someone on the staff who's not a doctor.  And they pay for visits to treat actual medical problems.  But an annual physical for someone who doesn't have any medical issues?  That's not covered by Medicare.

Some offices code it in a way that Medicare will pay for it, but they shouldn't (Medicare fraud, anyone?) and there's always a chance they'll insist on coding it properly, and plenty of people have been surprised to find out they have to pay for it themselves.  They're always pissed off a the doctor's office, but it's not their fault.  They're just following Medicare's rules.

It's one of the (many) irritations of Medicare.  (Advantage plans do pay for an annual physical--it's one of the "extras" they provide that Medicare doesn't.)

[GlennWest]

I am aware of the wellness visit. Here in Huntsville when I currently at the local doctor gave me a physical and stated he always does with a new patient to get a baseline of Any isuses. Stated if Medicare doesn't cover he asorbes it.