Advice Needed.

[rousemark]

My BIL is 72, original medicare, no supplement and a plan d with a deductible that he is paying $53 per month for. He gets extra help to pay his medicare premium.

A lady is talking to him about a UHC 0 premium advantage plan. He has several severe and chronic health problems. What would be the advantage of one over the other? All his Dr. Are in network with the MA and it appears he would no longer pay for his part D. Thanks in advance for your input.

 

[Todd King]

In his current situation he is exposed to the 20% that Medicare won't pay. As you well know, you can rack up some hefty bills with just one incident. The MA plan would at least limit his exposure.

One thing to watch for though. His medications may come with more cost sharing than he currently has. That could be a huge offset depending on the medication that he's on.

 

[TN_agent]

Given his medications are on formulary and network is sufficient,( sounds like both are true), an MAPD can be superior to just having original Medicare, for the fact that OOP is capped. If he can't pass medical underwriting for a supplement and is not eligible for Medicaid, an MA could be a good choice.

If he starts having tons of specialist visits a month, that can add up quickly though and cost more than original Medicare would. Depending on what they charge, a $35 or $40 copay may be more than 20% of the Medicare approved rate that would apply under original Medicare. I know I have someone who sees a psychologist weekly, and it is a lot less OOP for her to be on Original Medicare after Part B deductible (it is around $20 a visit) than shelling out $40 each visit.

 

[junkman]

Look at the out of pocket and what would cause him to hit it if he goes on the Advantage. There may be another carrier that is better.

Strange how people don't buy a supplement then squirm when they get sick. I have a friend that has refused life insurance for years and is suddenly willing to buy a graded policy now that he has cancer.

 

[jensing0406]

My BIL is 72, original medicare, no supplement and a plan d with a deductible that he is paying $53 per month for. He gets extra help to pay his medicare premium.

A lady is talking to him about a UHC 0 premium advantage plan. He has several severe and chronic health problems. What would be the advantage of one over the other? All his Dr. Are in network with the MA and it appears he would no longer pay for his part D. Thanks in advance for your input.

Sometimes a 0 dollar plan may not always be the best option. If you go on medicare.gov and under plan finder check that they have extra help. A lot of times plans with premiums will be greatly reduced in price and offer lower copays and better benefits. In rhode island we have plan2 with uhc that is normally $24 but with extra help its 5.70. It has better copays less max out of pocket and offers 2000 in comprehensive dental at a $0 copay. I've been selling this plan to people who don't have extra help just based on the dental benefit alone.