Good News About My Medicare Plan

Discussion in 'Chit Chat' started by Mikie, Sep 16, 2012.

  1. Mikie

    Mikie Moderator

    Got good news in the mail from my Medicare Advantage plan. I had thought that with cuts to these plans, I might have to start paying a premium or higher co-pays. Part of Obamacare was to cut payments to these plans because they are so efficient that the insurance companies were making a killing off of them. The other part of Obamacare is that insurance companies have to use a certain percent of revenues for benefits for members. So, even with the cuts to my plan, there were excess revenues which have to be used in 2013 for benefits. I now have no co-pay to see my PCP, the maximum out-of-pocket has dropped, and Rx benefits are better. I couldn't believe it. Some good news for a change.

    Love, Mikie
  2. Mikie

    Mikie Moderator

    Most Advantage Plans, with the possible exception of Kaiser (is Kaiser still around?) are HMO/PPO plans. In highly populated areas, most of these plans have no premium so you only pay when you use it. If I go out of network, my co-pay is $40. That's a big co-pay but it's cheaper than paying premiums for me. It's a different situation everywhere so what applies to me likely doesn't apply to someone living elsewhere.

    The Affordable Care Act is more than 2,000 pages long. Many of the changes do not go into affect until 2014, so it's no wonder that it's difficult to figure out. I think just being able to stay on one's parents' plan until, what is it? 26 now, is a big deal to many. Also being able to get insured regardless of pre-existing conditions is a good thing as is not getting one's insurance cancelled if one gets sick. I think when people see the advantages, they will like the plan and a lot of people who have no insurance will now have it.

    All I know is that I'm a happy camper.

    Love, Mikie
  3. Mikie

    Mikie Moderator

    I shouldn't get excited just yet. It could be that with cuts to providers, some of my docs will stop taking M/C. Down here, in God's waiting room, though, Seniors are the medical profession's bread and butter.

    Love, Mikie
  4. TwoCatDoctors

    TwoCatDoctors New Member

    I just got the 2013 plan for my Medicare Advantage HMO and I too will have zero dollar doctor office visits, reduced payments for everything else, and prescriptions for Tier 1 went to $3 for 30 days, Tier 2 to $5, etc. If you use their 90 day mail order they are reducing the cost more.

    Also, they are covering Armour Thyroid now too in their allowed prescriptions at what looks like $45 for 30 days or $90 for 90 day mail order.
  5. Mikie

    Mikie Moderator

    That's great. I think my Rx's are the same. The peptide injections have "cured" my hypothyroidism. The doc said they likely would but you know I hate to use the C word. So, I don't have to take my Synthroid any more. Yea! One less Rx.

    My co-pays to docs outside the network went up $5. I only use my eye doc and my dentist who are not in network. Just had my eye exam and everything was great. That's expecially good news because the fall could have damaged something. I'm back to wearing my contacts when I want to because I don't have the dry eye from Sjogren's.

    I'm glad your Advantage plan is doing so well for you. I hope we can keep these plans. I love mine.

    Love, Mikie
  6. TwoCatDoctors

    TwoCatDoctors New Member

    My two specialists that are not in the HMO, but the HMO covers them, I now have to pay $45 a visit instead of the usual $35--next year it will be $30 whether it is the HMO or the two specialists outside the HMO. So it will be reduced and I'm happy. Shelby the cat says "oh good, more money for cats" and she's making a list of everything she wants.

    That's fantastic news about your hypothyroid. I, at least, was able to move from Synthroid to Levothyroxine (spelling?), the generic for Synthroid, and I was able to do it okay and it's less money. I had to go through some blood work for a few months because the doctor said that some people do not change over very well to the generic so that's why he has to do the repeated lab work.

    I used to wear contact lenses (the extended wear) for many years and I loved them. I would only wear them for a week at a time and then I would wear eyeglasses on the weekend while they were cleaning and soaking. I had a slight allergic reaction to some of the solutions, so after cleaning, I would have to soak them almost a full day in a solution that wouldn't irritate my eyes. Then I could put them back in Monday morning and they would be fine. Eventually I got two pairs and that worked so well so that I had lenses all the time. They helped me in seeing so much better for the computer and driving. Then I eventually had the lasix surgery and that was fantastic.
  7. Mikie

    Mikie Moderator

    Jam, most of the Advantage Plans are now HMO/PPO so you can use any doc who takes that plan. Of course, if your docs don't take that plan, the Advantage plan isn't for you.

    2Cats, I also went from Synthroid to the generic and saw no diff. I didn't need Armour as my body would convert the med to my needs. Now, it's just great to get rid of one Rx.

    I don't wear my contacts as long, or as often, as I used to. I love these glasses, the first pair I've ever felt comfortable in. Still, it's just so nice to put in the contacts and not worry. I forget I even have them in. With monovision, it's not perfect but good enough. I also have just reading glasses from Joy Mongano on HSN. I also have her bifocal sunglasses, so I really have so many options. With my Kindle, I can enlarge the print just enough to make it really easy to read.

    It was so great yesterday to get a good eye health report and that my correction hasn't changed. I don't have glaucoma but my eye pressure is sometimes above the ideal. It was even good yesterday. Mom had the same thing and she never, in her 92 years, got glaucoma.

    I'm glad Shelby is counting her blessings too. This windfall might just buy a lot of kitty goodies. I haven't seen Simon and my neighbor, who walks her dog early, said she hasn't seen him either. He moves like a little ghost in the dark. Someone is eating the food I put out so I hope it's him and not just the possums. Tweety was acting like Simon was out there yesterday morning; I hope so. I've been looking for toys for the cats but just haven't seen anything I think the cats would like or don't already have. I think the Cat Nation should organize a protest because there are more toys for dogs than for cats. Of course, cats get bored with their toys and a dog will play the same game with the same toy over and over. Actually, right now, the cats seem more interested in being outside than inside playing. It's not as hot out and they are more frisky.

    Love, Mikie
  8. mbofov

    mbofov Active Member

    Mikie - I just glanced through the new Medicare booklet for California, and there are only 12 PPO or fee-for-service plans, out of 102 plans. The rest are all straight HMOs. There are no combination HMO/PPO plans in California. Maybe Florida is different than California?

    Plus you do have to pay a premium for the PPO plans, at least in California. There aren't any with a zero copay.

    So if you want an HMO with zero copay, there are plenty to choose from, but you are stuck with all the disadvantages of an HMO, - lack of integrative medicine doctors (I haven't met any who take an HMO), capitation fee plan, etc.

    I broke my foot 5 years ago when I was on Scan (an HMO) and had to go to the ER. That visit was covered just fine. But to go to an orthopedist to have a real cast put on and see a doctor who knew how to treat breaks, I had to get pre-approval, which meant several phone calls and following up with people and demanding that something be done. I really had to be on top of it. Otherwise I could have been waiting up to a week to see a doctor. I knew of one elderly woman on Scan who broke her arm, who waited almost a week to get approval to see a doctor for it. She wasn't capable of haranguing the people who make these decisions. So HMOs give me the willies. (not just for that isolated incident) But for the hurried, one-size-fits-all medical care, lack of knowledgable doctors, etc. And am so grateful for straight Medicare which has enable me to see some very good doctors I would not have been able to otherwise.

  9. Mikie

    Mikie Moderator

    You are right; in some places, there aren't many options. My plan used to be just an HMO but it was a good one which used the fee-for-service model. I was happy with it. In reality, it was the same as the one I have now because, even though it was an HMO, it did pay for out-of-network services, making it, in fact, and HMO/PPO.

    I think it's because I live in FL, God's Waiting Room, that we have so many options. We only have a few Advantage plans but the top two, United HealthCare and BC/BS, are bascially the same. Both BC/BS and Humana have pulled out of the market and that makes me wary of them. UHC is the largest and most stable.

    I've always maintained that each person has to choose for herself, based on personal needs. The best situation is M/C with a good supplement. I would have that if I didn't have this option which works well for me and saves me a bundle.

    Glad you like your plan.

    Love, Mikie

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