Insurance

[susandennis]

So one of the things I'm learning with Joan's Adventures In Heathcare is that I have an insurance problem.

I've had Humera Advantage forever. Fortunately, I don't need them much. I get my inhaler free from them every year. I used to get $ for exercise and free gym membership which I used for the pool but that was really about it.

I've now dug into insurance for here... if/when I need nursing care, will my Humana insurance be a problem and turns out the answer is yes! Apparently they cover some stuff but not all and getting approval has proven problematic for many. When I wanted physical therapy, they took more than 10 days to approve. If I need nursing home care, I sure as hell am not going to be interested in fighting my insurance company.

So divorce is imminent. I can't change until Oct 15. So I have about 5 months to research and decide. The wellness direct here (who used to work in the nursing section) says they recommend Medicare only - not advantage plans and she is very very high on Primera Blue Cross (a Washington state company). She also gave me a short list of insurance companies to avoid at all costs.

And so the hunt begins. Primera Blue Cross had about 5687 different options for old people. They have supplemental and advantage plans.

This is not going to be fun.

Comments

[wpadmirer]

Do not do any Medicare Advantage plans. They actually take you off Medicare. Get Medicare A and B, find a good pharmacy program, and then get a supplemental plan. If the Washington State plan is good - go with it.

I have Medicare A & B, Humana for pharmacy, and AARP's United for my supplemental insurance. My understanding is that currently the Plan G is the best with them.

They quit selling the Plan F which Pat and I have. It's got a 0 deductible and covers whatever Medicare doesn't. It's excellent. It's not cheap, but well worth what we've paid for it, considering I've had surgery since we got it.

[susandennis]

I disagree with your premise and those plans will not work for me. I've been on advantage plans for a decade. I've saved a bundle in that time. Different strokes for different folks.

[wpadmirer]

I'm just glad you didn't have anything major. It is truly awful coverage if you do.

[susandennis]

I should have added that just as I do not do tests because the outcome won't matter, if I should contract something major, all I would need is coverage for comfort care. I'm not going to be striving for wellness.

Like I said, different strokes...

[arlie]

When I hit 65, I followed the advice you gave here. I have a G plan, and a D plan for prescriptions.

I've avoided HMOs all my life, and Advantage plans are all HMOs.

More importantly, I already had a history of cancer. I was advised that the traditional Medicare plans can reject you if you try to switch from an Advantage plan, or even a traditional plan with lesser coverage. They reject on grounds of health - i.e. if they expect you to be more expensive for them than average. Any history of cancer increases the odds of future cancer, which is extremely expensive to treat.

Some plans - in particular, AARP's United Health plans - publish a short set of existing conditions which cause rejection; AARP's does *not* include a history of cancer. But presumably they could change that any time.

But they can't reject anyone if they are enrolling in Medicare for the first time. So I went straight to a G plan.

p.s. susandennis is right about the relative costs. The Advantage plans cost much less. I'm betting that in practice, you get what you pay for, and in the long run I'll get better care for less total cost.

[susandennis]

In fairness, I should mention that I do not have any major anything. The one inhaler and that's it. And, in the grand scheme, it's not major. Plus, should I contract something major all I would need is coverage for comfort care.

[arlie]

Some major health problems have an excellent prognosis, with treatment.

Once they got a biopsy of my tumor, they could tell me I had only about a 10% chance of the cancer coming back - ever, not merely in the next 5 years. (It's now less - if it were going to come back, it would be more likely to come back sooner than later.)

I still don't feel old enough to throw in the towel with a prognosis like that. (It would be different if I had something where treatment was only likely to give me a couple of extra rather miserable years.)

But OTOH, you are older than me. And eventually the collection of daily unpleasantness due to a failing body presumably ruins quality of life. (Some days, I already have to remind myself that whatever symptom I'm dealing with only happens some of the time.)

[arlie]

*hugs* I hear you on the delights of comparing Medicare plans. Good luck.

[desdemonaspace]

I will be VERY interested to hear what you choose. Can I ask, is Ucare one of the ones to avoid at all costs? (Ucare is my supplement to Medicare.)

[susandennis]

nope BUT i think she was saying these are the ones to avoid because of their incompatibility with our system here at timber ridge.

[desdemonaspace]

Thanks. I don't need it yet, but down the road I may need assisted living or memory care.

[mdlbear]

Yeah-- Medicare A, B, and D (drugs); and a supplemental policy (I use Premera and haven't had much trouble with it, except that they won't pay anything for things that Medicare doesn't pay for. I'm using AARP for dental.

[carriea31]

I know absolutely zero percent about Medicare, but from working for a pediatrician for 22 years, I'd agree with the person who recommended a BCBS plan. They seem to be more straightforward in their terms than other carriers, and don't try to hide things that they will not cover in hard to find, weedy places.

[adafrog]

I hate that there are so many options. It makes it so difficult.

[kaishin108]

I have True Blue thru Blue Cross for free on top of my Medicare. It's a PPO. No problems so far but you are looking at a specific issue of course. I like mine cuz it's free and has worked so far. Includes vision and delta dental.

[melshutterbug]

I'm glad you are looking into this now. So many options that look good but such. I'm glad you talked to the wellness director too. Around our office, we always hope that patients ask us what we think of insurances. There's one here that physical therapy copay is $40. It's an Advantage plan. I'm really starting to believe there isn't an "advantage" to these plans. Good luck!