Turning 65 Florida - Medicare Help, Please

[samgood]

Sheesh...this is even more complicated than I thought. I do thank you
j10, yogooglethis, Iwillpay and Chazm for your replies.

So you mean on top of the Medicare Part B I must pay from my SS amount, I need to add from $65 to over $175 more? Yikes, this not working for me. My Obamacare premium and coverage are quite comfortable, and now this seems like a downer.

What j10 said...

_You could also go with a PPO MAPD, of which there are a couple available for $0 a month from a few companies available from national carriers. These do allow you to use your plan without referrals at any A and B provider that accepts Out of Network payments. With the national carriers you usually do get the ability to transfer in-network benefits out of state at participating providers. (UHC and Humana come to mind with this ability sometimes) These could cover your Part D at no additional premium, and you get a first year trial right where you get to go to a Supplement at any time, no questions asked if it doesn't turn out to be a good fit. You don't get the same right in the opposite direction, so take that into account as well._

Okay...this sounds better, I think. Any problems with this, please? I think this is what my friend, who lives here in Sumter County, says she can use when she travels to Michigan.

Kudos to you agents who understand all this and advise your clients accordingly.
AND make it easy enough for them to understand just what it is they are getting.

 

[MatthewC]

if you are considering a Medicare Advantage Plan, there is a differenc between how Humana and United Healthcare handle out of state care.

Humana's "in-Network" includes any doctor in the U.S. that is contracted with a Humana Regional PPO. You can see them at any time.

With United Healthcare's Regional PPO you need to give notice of when and where you are going, and need to be away for at specific period of time. (months).

If you are RVing around the country, neither will give you complete coverage.
https://medigapseminars.org/blog-posts/index-of-resources-articles/

 

[FLM2]

Sheesh...this is even more complicated than I thought. I do thank you
j10, yogooglethis, Iwillpay and Chazm for your replies.

So you mean on top of the Medicare Part B I must pay from my SS amount, I need to add from $65 to over $175 more? Yikes, this not working for me. My Obamacare premium and coverage are quite comfortable, and now this seems like a downer.

What j10 said...

_You could also go with a PPO MAPD, of which there are a couple available for $0 a month from a few companies available from national carriers. These do allow you to use your plan without referrals at any A and B provider that accepts Out of Network payments. With the national carriers you usually do get the ability to transfer in-network benefits out of state at participating providers. (UHC and Humana come to mind with this ability sometimes) These could cover your Part D at no additional premium, and you get a first year trial right where you get to go to a Supplement at any time, no questions asked if it doesn't turn out to be a good fit. You don't get the same right in the opposite direction, so take that into account as well._

Okay...this sounds better, I think. Any problems with this, please? I think this is what my friend, who lives here in Sumter County, says she can use when she travels to Michigan.

Kudos to you agents who understand all this and advise your clients accordingly.
AND make it easy enough for them to understand just what it is they are getting.

If you can't afford the premium for a supplement above your Part B plan (which many in Florida can't) then a $0 premium Medicare Advantage plan makes sense.

If you are traveling around the country in an RV it is unlikely you would need medical care unless it is either Urgent Care or ER, those are covered In Network anywhere in the country on any plan.

Sumter County has several smaller companies that offer plans centered around the specific needs of residents of The Villages, they have lower out of pocket costs than the Regional PPOs of the national companies offering plans (UHC and Humana).

I know you were told by another agent that Humana allows you to see doctors in other states who are part of the RPPO in that state but I was told differently by a Humana rep, who told me it would be covered as an Out of Network visit (Humana's plan has a $975 out of network deductible). I'm not sure which interpretation is correct but have a number of clients on the Humana RPPO and it is a good plan but I'm not sure I would recommend it for someone who travels out of state for much of the year.

If I were you, given your limited budget, my choice to start would be the UHC Medicare Complete Plan 2, the potential out of pocket might be slightly higher than Humana (assuming everything is in network) but it gives you maximum flexibility since there is no out of network deductible.

Many people in your position spend way too much time agonizing over this decision, it is far easier to listen to an experienced agent and start with a 'safe' plan that can be changed if you are unhappy-for example, your coverage begins in September so you are only making a 4 month decision on the first choice, if you are not happy you can pick a new plan for next year during the Annual Election Period. If you are really unhappy with a Medicare Advantage plan, there is, as others have said, a 12 month trial period to switch to a Medicare Supplement without answering health questions but the reality is that almost anyone who can 'fog a mirror' can get a United Healthcare/AARP Medicare Supplement at any time as there are only two health questions and the only real restriction is that you have to wait 90 days after a hospitalization to get covered.

 

[DCN]

1. Strongly agree to find an independent that sells both Supp and MAPD.
2. Re-emphasize that you have ER/Urgent care coverage everywhere with ANY Mapd, just get your routine stuff done on home turf if you go that route.
3. Agree if you're driving an RV, should be able to afford a Sup. Traveling a lot just smells Sup for you. Also, MAPD is always there for you every fall. However, without knowing any other details, you have just this ONE Guaranteed Issue Period for your Sup. If that concerned, start with Sup knowing you can always go to MAPD. Your 12-month trial grace period for MAPD starts when/if you ever try one. It's not limited to when you turn 65.
4. Just me, but I like Plan G for Sups. For MAPD, I like 0 premium anything, and maybe something without referrals. Not all HMO's require them FYI.

 

[vic120]

if you are considering a Medicare Advantage Plan, there is a differenc between how Humana and United Healthcare handle out of state care.

Humana's "in-Network" includes any doctor in the U.S. that is contracted with a Humana Regional PPO. You can see them at any time.

With United Healthcare's Regional PPO you need to give notice of when and where you are going, and need to be away for at specific period of time. (months).

If you are RVing around the country, neither will give you complete coverage.
https://medigapseminars.org/blog-posts/index-of-resources-articles/

2 years ago I had inquired Humana about snow bird's and was told they do not reciprocate networks across states and with PPO they would still have to be in service area, With emergency service as only exception.

For this reason when MA was necessary I had leaned AARP,Some Aetna plans

Has this changed?

 

[Chazm]

1. Strongly agree to find an independent that sells both Supp and MAPD. 2. Re-emphasize that you have ER/Urgent care coverage everywhere with ANY Mapd, just get your routine stuff done on home turf if you go that route. 3. Agree if you're driving an RV, should be able to afford a Sup. Traveling a lot just smells Sup for you. Also, MAPD is always there for you every fall. However, without knowing any other details, you have just this ONE Guaranteed Issue Period for your Sup. If that concerned, start with Sup knowing you can always go to MAPD. Your 12-month trial grace period for MAPD starts when/if you ever try one. It's not limited to when you turn 65. 4. Just me, but I like Plan G for Sups. For MAPD, I like 0 premium anything, and maybe something without referrals. Not all HMO's require them FYI.

But like you mentioned before, he should talk to someone who knows the FL market. Plan G is NOT a wise decision.

 

[case1]

For how much I read and try to understand it, I draw a complete blank on Medicare. Maybe I am shocked I got this old, but.....

Turning 65 in Sept. I have been told I need to register either 3 months before, or in September, or 3 months after. Huh ?

Then, what to choose.... I have friends on Medicare and Medicare Advantage.
They tell me different things regarding coverage and traveling. One who is on Medicare Advantage tells me she can travel and get care because she has a PPO. For sure I don't want an HMO.

I live in Sumter County. I don't need the Part D, but have been told I will get a penalty if I decline it. I also do not have any chronic conditions that need a lot of care. I think it is a good idea to have blood work done at least once a year.

I am a new RV'er. I hope to travel soon and may be gone for months at a time. So I need a plan that I can use wherever in the U.S.

I am currently on Obamacare and have been told through the Marketplace that I will keep that plan until the end of the year, then go on Medicare.

Any help with this will be appreciated. What to do? Thank you.

What Newby said. I personally like and recommend Medicare Supplement Plan G paired with an inexpensive Part D...Humana Walmart or Aetna Rx Saver. You'll be glad you did.

 

[Ron Van D]

But like you mentioned before, he should talk to someone who knows the FL market. Plan G is NOT a wise decision.

I'm not familiar with the Florida market. Why is it not a wise decision?

 

[axeman462]

I'm not familiar with the Florida market. Why is it not a wise decision?

The math doesn't make sense. For example: Plan G with Cigna for a male T65 is $198 and female is $172. Meanwhile, you can get a Plan F for $175. Or even more bang for your buck, a plan N for in the range of $125

 

[MatthewC]

I know you were told by another agent that Humana allows you to see doctors in other states who are part of the RPPO in that state but I was told differently by a Humana rep, who told me it would be covered as an Out of Network visit (Humana's plan has a $975 out of network deductible). I'm not sure which interpretation is correct but have a number of clients on the Humana RPPO and it is a good plan but I'm not sure I would recommend it for someone who travels out of state for much of the year.

If you are unsure, you really shouldn't be commenting on it as if you were an authority. I offer both Humana and UHC MAPD plans as well as all the Supplements and am based in Florida. I am very familiar with the features of these plans. I can assure you the out of state in-network coverage with the Humana Regional PPO includes, as I wrote, all doctors in the country that are contracted with any Humana Regional PPO. That is stressed in the Humana annual training.

Also, be careful about suggesting emergency care is covered as if it is no big deal. They cover emergency treatment, but many MAPD plans then require you, once you are stabalized, to travel back to your network area for further treatment at your own expense. Being stabalized does not mean being mobile. You may find yourself paying for a medically monitored ride back to your county from whever you are.

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2 years ago I had inquired Humana about snow bird's and was told they do not reciprocate networks across states and with PPO they would still have to be in service area, With emergency service as only exception.

For this reason when MA was necessary I had leaned AARP,Some Aetna plans

Has this changed?

There is still a lot of confusion. However, the current Humana training and sales material all stress that "in-network" inludes all Humana RPPO contracted doctors. If a doctor is contracted with his/her local Humana HMO and NOT the RPPO then the doctor is not in-network. It must be one of the regional PPOs which are active in every state.

Call Humana. They have the best answer on this. i will post a copy of the sales material shortly

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Florida is a very different market than almost any other state.
Prices for Medicare Supplements defy economics.
It is one of the most expensive states in the country for Supplements.
At the same time, Florida has some of the best MAPD plans in the country, with two that are wells uited for Snowbirds.

Plan G does not make economic sense. It some areas it is more expensive than Plan F.
Plan F-HD is a great value because the $2,180 MOOP is equal to or less than the premium for Plan F in many parts of the state.
Plan N is also priced at a good value.

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Quote from Humana Regional PPO material:

"If you are away and need medical treatment, you can call Humana to find out if there are HumanaChoice PPO (Medicare PPO) contracted doctors nearby. If so, you can see them for in-network rates."

This is different than with UHC that requires prior notice of being out-of-coverage area, and you must be out of the area for at least 4-months.

I hope there are not agents selling these plans without having read these details and fully understand the remifications.