Need Advise, please!
 

:confused:I am turning 65 in august, have been on disability for last 16 years, now I am able to get insurance, I don't get lot in my payments so I am looking at an HMO and PPO. In my area there are only 4 that I can get. I am going crazy trying to figure which is best fo me. The PPO doesn't require a referral to specialist and the HMO does. The only HMO is secure horizans aarp classic or something like that, anyone have any suggestions

Poochie there are many great folks you can talk to that will explain those plans. Your pharmacist or your nurse at the MD office. Try to keep in mind when you pick a plan that you want a plan that covers the people you see most. you dont need a dentist if you have dentures, so why pay for dental? You dont need OB care if you are done having babies so why pay for that part?

HMO means you see THEIR MDs and only their MDs. you will need permission to see a special MD like a neuro, or dermatology guy. EVERYTHING needs pre approval, but those places tend to have lower rates and are more affordable for those without many health conditions. I always say an HMO is a great place for wellness care. yearly checkup, routine care and such.

If you are sick or riddled with issues, you may wish to pick another type of plan. One that doesnt have a gate keeper to ask for permission should you want a wart looked at, or a mole checked. The upfront cost tends to be higher, but it gives you a wider range of places to go be seen. You can usually pick most any MD that will accept that plan. ASK UPFRONT if they take your insurance or you may be stuck with a bill.

Please dont navigate this alone, please find someone you can trust to help explain it to you. A pharmacist is a good person if you can pop into the local drug store. They are free and knowledgeable.

pooch,

i couldn't agree more with dej's assessment.

i generally don't care for HMO's. they live and breathe to keep their costs down.
of course it really depends on what your needs are and what you can afford.
PPO's give you a bit more freedom and choice.

but, investigate both. they will also both send you their paperwork.
also, ask for their websites and you can read and compare their rules.

the pharmacist is a great idea. if you are on a lot of meds and HMO just might not cover your needs.

I just found out that if I take a ppo and want to drop it after 2-3 years or if thet arn't doing me right, I cannot get on a supplement because of ms. I have to make my decision in the next couple of month or be stuck with what I choose If I get a supplement it will cost me $98. mo and I don't have a lot of money to spare and it will go up every year. This is not fun.

With Medicare there are no restrictions on changing plans. During the annual change period, was Nov 15 to Dec 31, now Oct 15 to Dec 31, you can change to any plan available in you area. There are no premium plans that have a high deductible, usually about $1400. You do have to have Part B though.

MS will not have any effect on your changing plans.

I suggest you contact your Area Agency on Ageing (they will be called by a variety of names, but look for one who is your region'sA.A.A.) For example my local AAA is Senior Services of SEVA If you call your state government, Social Security Administration or look in the blue pages you will find a department who has this list of AAAs. (I can''t be more specific as I do not know what staet you live in) They provide free counseling on your best options, based on your health, medications, doctors, and finances.

I have used them for years, as have several friends, and we swear by them as they are unbiased. The government pays these organizations to counsel folks on Medicare plans (and work with anyone on/soon to get edicare, regardless of age)

I am just on Medicare A&B alone. And since my meds are inexpensive, I didn't even add the drug coverage. $98. per mon is more than I pay in medical costs over Medicare ded.

You could try just plain old medicare, if your situation allows it and add supplemental ins, later, if you need to??

:hug:

I don't know if all insurances are offered in all states but I am on Anthem Advantage. Most of my medical needs are for my medicine. The monthly premium is $14 and I pay my co-pays for my meds. With my Avonex it doesn't take me long at all to get in the catastrophic period of the progam. I am in it by the end of March. My Mom took the same program because she saw that very low premium and just knew it was for her. But it was the worst thing for her. She never got into the gap, most of her costs were doctor visits and diagnostic tests and procedures such as spinal blocks. Our local insurance agent helped us. Plus one of the billing offices that did one of her blockes just told her that she was on completely the wrong insurance. She just needed to be on Medicare A & B! So she went with that and luckily we also went for a supplement. Mutual of Omaha has one that just ask if you have end stage renal disease. That's the only health question they ask. She didn't like the premium but it took care of ALL of her nursing home costs after the traditional month that Medicare gives. It sure saved her bank account. She would have been in so much pain being cared for at her retirment apartment at the end.

Every one and every case is different.

I've learned that if you don't get a supplement within 3 mos before and 3 mos after your birthday then you will be asked all types of health questions and it will cost you more, I think I am going with an advantage plan called Bravo, there is no premium and monthly charge and due to my income I can change at any time and not wait until the open season. There is so much to learn about this and there are changes the gov. makes so you don't know the exact choices to make, just take a chance.

With Medicare there are no Health Questions, all is needed is you have to be eligible. For a Supplement to cover your Copays there may be some, but why? I have Blue Cross HD, no monthly premium and is a Part D Plan. I do pay most expenses until I reach the Maximum, but not Doctors. They are only a copay.