Medicare Insurance AZ staff answers:

So. Lets just say I have as close to a degree in Medicare as you’re going to find in the Middle Tennessee area. I can tell you how to answer the question for yourself. Your answer depends on several factors. The first thing here is going to be pretty simple to determine, do the doctors in your area take the medicare advantage plan you’re looking at? Look at some plan summaries and call the doctors you plan to use. There is a 0 dollar plan in a few TN counties that is FANTASTIC from BlueCross BlueShield of TN, or in others there is a HMO from Healthspring, and they’re great. Frankly in the counties where BCBST has that 0 dollar plan I won’t suggest any other MA plans. In other areas there is a Humana plan that, no joke, the hospital in a town it can be sold in will not take it. The big advantage you’re going to have with most any MA plan is that there is an out of pocket limit, with original medicare there is not. There is typically no deductible, and usually the co-payments are very reasonable. A lot of them are going to have prescription drug benefits, and again, with original medicare there is no prescription drug benefit without adding a part D plan.

There are 3 different types of coverage in MA plans, HMO, PPO, and PFFS. HMO is network only, other than emergency, you HAVE to use in network doctors. PPO is cheaper if you use in network, but you can choose to use outside doctors. PFFS has no network, but the doctor can decide on a case by case basis if they will accept the plan conditions. They can at ANY TIME say, sorry we aren’t going to accept this plan anymore, and refuse to provide care. It is an unlikely scenario, but it can happen. With any of these plans you are supposed to live within the plan area for most of the year. They are not great plans for travelers in general. If you go out of town a lot, medicare supplement plans are probably better for you. The benefits available with supplements again are going to depend on the state and county you are in. I do not have knowledge of every state’s available plans. In my state, the F supplement is the easiest to understand. It covers 100% of all deductibles and all co-payments for medicare approved services. You do not pay anything more than the F premium monthly. Since you are about to become eligible I would strongly suggest looking at F supplements if they are available in your area, because when you first become eligible by turning 65 or leaving your employer group coverage a F supplement is guaranteed issue and subject to no medical underwriting.

I would personally suggest looking for an independent local agent that can help you out with this, so if you need questions answered they can help you out later on down the line. That is the first thing I would do if I was in your situation. Find someone you can trust, make sure they’re licensed, and make sure they carry a variety of products. Prices change rapidly, you do not want to have to change your agent because a medicare supplement price went up a lot and someone else’s is now the best deal in your market but they do not sell it. You need to find someone that can help you fit with a plan that will be crafted to your individual health and needs. It takes a lot of research even for an agent that knows what all the plan options mean to understand the different plans in any given area. If you are in TN I’d be happy to help you, but I typically try to only work in about a 50-100 mile range of my home, so if I need to visit someone in person I can.

Medicare Insurance AZ staff answers:

He is not currently planning to eliminate the Medicare Advantage plans. The house bill in section 1161 has a reduction in payment to those plans, which will result in you paying higher premiums and/or co-pays. Section 1162 will give the Medicare Advantage plans a bonus payment if they are rated as a “High Quality Plan”. The quality is based on several items, most of which are out of control of the plan, and to qualify for the bonus the plan must be in the top 20%. They’ll measure such items as admission and readmission to hospitals and measure of patient mortality following surgery. Who really knows how this will affect you or the plans.

Section 1181 stipulates that drug companies must rebate the cost of medication for people who are also on Medicaid. The rebate doesn’t go to the beneficiaries but to the government. This will cause drug co-pays for everyone to increase.

Section 1182 stipulates that drug companies must discount certain medications (to be determined) during the donut hole, which will also increase drug co-pays.

Section 1151 will reduce payments to hospitals and doctors if you are readmitted to the hospital. This will result in longer hospitals stays which will cause the Medicare Advantage plans to increase the inpatient hospital co-pay. It will also result in overcrowding of hospitals because hospitals will be forbidden to increase their capacity in many cases.

Medicare Insurance AZ staff answers:

Remember that employers and employees not covered by Medicare are still paying into the system. No one knows how long Medicare Advantage will be around. Some hospitals do not accept and seem to rather wait for the traditional Medicare to pay them directly, even though they receive limited money for each service rendered.

The amount to the agent is not huge. On most health and insurance products we get a larger commission during the first year and then a small amount in the following years if the products are renewed. Sometimes we are charged back if the product is cancelled. There is no additional compensation paid to agents after the initial payment that I’m aware of.

Medicare Insurance AZ staff answers:

Because we don’t know what is in it until we pass it.

Nancy? Is that you?

Medicare Insurance AZ staff answers:

I’m not going to do your homework for you other than to say competition always matters except in very few cases.