Medicare Advantage plans - opinion?
 

I have Social Security Disability (no SSDI) and so does spouse. Any opinions pro/con on regular Medicare with a Part D vs. Medicare Advantage.

I am stressing over costs and wondering what you all find works best for you.

I'm just on plain ole Medicare.....no extras so I can't help you much....I have heard that there are medicare plans with outside Ins Companys, that cover more, at no extra cost.......especially for those who have chronic illnesses.

Put "Evercare" in your browser and you will see what I mean..:)

i'm a nurse and i'm just prejudiced against HMO's.
i personally don't like to be limited in care i seek. like picking a dr or hospital.
and sometimes the care is doled out. IMHO.

however, if you have to watch $$$ an HMO is a good deal.
i'd look around for a high rated one. for instance here in CO Kaiser is rated very high.

if you're in original medicare you can go anywhere you want; dr or hospital.
and, if you are one to travel you have access anywhere.

however, there's always a but, expect the costs to be higher.
i believe that i pay a lot for my meds. bear in mind that i'm on a lot of meds.
i pay for my medicare premium (about $100), then my part D premium ($150) plus the co-pays for my meds. then when you fall in the donut hole you may be required to pay up to about $4000 before your costs go down.

plus, i have a hx of needing a lot of care. so i get an AARP supplement policy. and i ended up having breast cancer and needing surgery. so it turned out to be a Godsend that i had the extra coverage (another $150) and all these costs are per month.

go to the medicare.gov site and you can compare plans for your area.
you can also call their representatives and they're very knowledgeable.

another thing i did when i was first deciding on all this last yr was talk to my pharmacist (Walgreens). they were able to run out info on about 6 plans in my area based on the meds i was on. VERY helpful.

Someone (Gazelle?) posted this site a few weeks ago. It's pretty thorough. You just type in your information and off you go!

http://www.benefitscheckup.org/

I have a Medicare BCBS Advantage HMO that includes Part D. It covers all Labs and Radiology with no copay. It is $82 per month.

I'm lucky that my husband's company covers the cost of my supplement plan but I like it - BCN Advantage.

It's an HMO but we have had BCN (blue care network) for about 25 years and never had any problems with getting to see specialists, going to hospital of our choice and what they pay is great! Right now we pay $10 for any office calls and $10 for 30 day supply of meds or $20 for 90 day supply. We have no co-pay on tests and preventative care is high on their list so husband and I get a complete physical every year, colonoscopy as recommended and of course the yearly mammogram. I have blood work done every 6 weeks with no cost, this is to check for any bad effects from meds.

I have a PCP in network so that helps but I have always been happy with my PCPs in the network. I have a cardiologist, neurologist, ophthalmologist and urologist and only need a referral from my PCP to see them. She usually just writes out a referral for 1 year of care each time so I only have to call when the referral has run out. Actually my specialists usually do the call for the referral.

I have never had any problems when away from home but the need has been minor, stitches for son, stitches for husband...

I have saved many an ER visit by calling ahead to doctor and luckily can go to their office instead of ER for x-rays, stitches etc.

The only thing I have ever had to "fight" for was the drug Cymbalta but doctor kept me stocked up with them until the insurance came through after 2 steps of the process of denial.

whoa, didn't mean to go on and on. And the good thing about the insurance choice you can always change it next year during open enrollment.

The book everyone on Medicare should have got in the mail about 2009 explains each choice, their costs and what they pay.

Good luck with your choice.

Thanks everyone! I have an appointment Thursday with an insurance counselor Thursday (my area's SHIP agency) who said to bring in all my MDs info, my meds etc and he will plug it all in to his fancy computer program. The software is easier and moe complete than medicares and will tell me 1)my best and 2) my cheapest options for reg medicare with a part D and also best and cheapest plans for advantage. He said he will give me his honest, experienced based opinions for my situation. This service is free also (yippee)

Wish we had a simple way to just get the care we need, the druga we need and all without going in the poor(er) house. All because we are 200 bucks over the medicaid limit in our state.

Jane --

I'm confused, because you say you are receiving disability, but not SSDI. Do you have SSDI (Social Security Disability Income), or SSI (Supplemental Security Income)?

~ Faith

I have neither. I have Social Security-Disabilty, but not SSDI (SSI and SSDI are income based, mine is based purely on a permanent disabilty thus I was granted early Social Security benefts due to disabilty before 65 y/o). I used to get a small SSDI check as I was below poverty limits and disabled, but am now $200 over the limit, thus just SSD benefits. (My checks actually say say SSD).

If you get any amount of SSI or SSDI you qualify for Medicaid in Virginia. Since I no longer get any SSI or SSDI I no longer meet the income test. I pay full premiums, copays, etc for Medicare and perscriptions. This is why I am looking into an Advantage program.

Thank you for your info Faith. Just was reporting what the Social Security person told me. Good to hear there is a way to verify what exact form of benefit one gets on the web. I imagine many of the SS workers are eiter ill informed (thus passing on bad info) or over-worked.

Back to my original post quetion:
Just wondering other people's experience with and without Advantage plans. I take several medications and see MDs at least 8 times a year (including for tests) as I also have 2 non-MS related issues. I am concerned about costs and trying to determine which avenue other people have found a good solution for them.

I have both Medicare and Medicaid. So, I may not be much help.

However, when I qualified for Medicare last year I called them to get help with choosing a plan. I chose the regular Medicare for similar reasons that Nurse Nancy stated - I could choose my own dr., hospital, etc. However, since I am on Medicaid too, it gets a little tricky as I still have to get prior authorization.

I also had the rep at Medicare help with the Part D plans and we came up with the best plan for me with minimal out of pocket costs on medications. Keep in mind that I qualify for extra help with this and my prescriptions (including Copaxone) are never over $3.10. Within a couple of months I met the deduction and now don't pay anything for my prescriptions.

Medicaid pays for my Medicare premium. Therefore, they don't deduct it from my SSDI check.

Additionally, since neither Medicaid nor my Medicare cover dental and/or eye care I found a clinic down the road that helps with this based on income. If you are on Medicaid your qualify. Just something to keep in mind as you may have a program similar to this in your area.

DDs each have different "insurance" through the state. However, since DD18 is considered an adult, she is on a plan that doesn't cover dental and eye care. I signed her up at this clinic as well.

Not sure if that helps you in your situation as this is just my experience based on my income (or lack of LOL).