Medicare Advantage shopping.

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Medicare Advantage shopping.

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Due to her dementia, we recently moved my mom out of her home to an AL near me, in a different county from where she lived. She recently received a letter from her Medicare Advantage plan saying her new address is outside of their coverage area, so I am going to have to find her a new plan. I have NO IDEA where to start. I don't know anything about Medicare at all, let alone "Advantage." Any ideas on where I should start??

Health Insurance Medicare Advantage Plans Medicare Open Enrollment

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Advantage plans are where Medicare contracts out to insurance companies to manage Medicare recipients. Insurance companies get the Medicare premiums that come out of your social security check. They want to make a profit so they have more control over which doctors you can see, which procedures you can have, what medications you can take, etc. Despite what they tell you, you will have copays and out of pocket expenses. They promote themselves by promising “extra” services that Medicare doesn’t usually cover. If you can afford it, go to traditional Medicare with a supplemental. Many of the supplemental plans require you to pass medical history questions. Some of them don’t cover Medicare deductibles and you could still have copays. I agree, sit down with an agent well versed in Medicare. My husband has dementia and his supplement with AARP united healthcare is $423 a month. His part D drug coverage is $120. You will need to do the math. Since she is in a facility, I’m assuming the facility provides her medical care. So check with advantage plans if they cover her care and medication there. Humana, UHC, BCBS, Aetna all have advantage plans and might be better than $6000 a year for supplemental medigap.

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Reply to Yesterdayanurse

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Pls pls pls take the advice to use this as an opportunity to move her back to Original Medicare and get her a supplemental/gap policy to cover what Medicare doesn’t.

Please contact the SHIP for your state. They work for the State and not any insurance company, so their evaluation as to what 3rd party health insurance exists for Part B in moms new zip code and what “mates” best for her drug plan (plan D) is something they routinely do. After this is done, then you contact the specific health insurance company for pricing their supplemental Part B and Part D coverage.

also there is an annual “Medicare and You” book printed by CMS (Centers for Medicare and Medicaid, it’s Federal) for each State. Your mom got one. If you cannot find it, it’s online or in the local library. It will go into detail as to what’s available in your State. Personally it can be beyond overwhelming to try to wade thru it. Especially if you are in a bigger State with lots of large metro areas (CA, NY, TX, IL). Here’s where your States SHIP consultation can come in handy.

the Medicare Advantage Plans make doing the above seem in excess and unnecessary. But AP imo really only work best for those who are relatively healthy and able to always completely on their own ONLY go to see the specific providers that are in the plan's network. Going outside their network of doctors and labs and healthcare facilities will mean out of network costs for anything and everything she does medically. This could be seriously expensive. And the billing can be very difficult to decipher.

Also another way to do this is ask at the AL she is in what the their residents use for their own health insurance in addition to their Original Medicare.

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Reply to igloo572

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Find an independent insurance agent who specializes in Medicare. Bring all of his medications name with you. You can also go to Medicare.gov to find a plan. Plug in his zip code and add in his medications. You can view and compare plans. The major decision will be on how much drugs will cost with the policy

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Reply to MACinCT

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I too would try to go back to traditional Medicare with a supplimental like BC/BS. Medicare Advantages tend not to be a good thing when the health problems start. Not Senior friendly.

Call your County Area on Aging and see if they have someone who can help you pick a plan for the area you live in. They were a big help to me.

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Reply to JoAnn29

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I would start by not buying any type of Advantage plan because it inserts itself inbetween one's Medicare and acts like an HMO, and undesireable IMO.

If she can afford a BCBS supplemental plan, I have loved mine these past 2 years. I've had a few surgeries, lots of PT and other procedures and have barely had to pay for anything. Plus, BCBS is has been around a long time and is more "portable" (ie covers you in some other states and even out of the country - limited, but better than nothing). I live in MN and my plan includes the Mayo Clinic even though it is almost 2 hours away in another county.

Sure, they are inexpensive and seem like a "good deal". Advantage plans are only an "advantage" as long as you stay healthy. They send you bandaids and OTC meds like generic acetaminophen and ibuprofen, but that won't be enough when the rubber meets the road.

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Reply to Geaton777

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Call your local insurance agent to help you, or there are services called SHIP(state health insurance assistance) or CHAPTER that can assist you as well.

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Reply to funkygrandma59

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Medicare Advantage shopping.

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