United Health Care: Your experience?

[Trivet]

I should have said for Medigap! I now bow down to the self-proclaimed Medicare expert!

Well that's rude. And inaccurate. Where have I proclaimed myself to be a Medicare expert?

Now, if you want to accuse me of being careful with words when dealing with Medicare? Guilty as charged.

It's a complicated topic, and made even more complicated because of the terminology. Medicare and Medicare Advantage couldn't be more different, but a lot of people don't even know that, and having such similar-sounding names doesn't help. Medigap? Is that an alternative to Medicare or Medicare Advantage? And then we have an initial enrollment period, open enrollment periods, and special enrollment periods. All of these terms have very specific definitions, yet people confuse them all the time.

And we have states with different rules for supplements, which means there are millions of people who can change their supplement without undergoing medical underwriting. Wait, what's a supplement? Well, it's the same as Medigap.

Oh, and don't forget Medicaid, which is not Medicare. But some people on Medicare qualify for Medicaid.

I don't see how trying to add a bit of precision in this landscape merits mocking.

 

[Big Mark]

I had Medicare and Medicaid then they talked me into the combo. They said I still have both but I got more like it was $300 a month now it's $290 to buy with as far as food or I use it gor over the counter med stuff all kinds of stuff.
But rite now my pain management doctor that they told me I could stay with needs his $750 because though they said I could still go to him , that was the only way I was switching it seems he's not part of their net work he only took my Medicare. Also like I said it's great for stuff I need like my vitamins or braces and it worked great just ordering over my phone. Now I've got to call them because nobody can figure out what's wrong. I'm also going through where they owe me like a grand of money I can use because I couldn't get through to tell them my order cause ordering on line wouldn't work.

Don't get me wrong it's a good deal , if they can get it to work rite. I'm gonna start to go to a gym and I can pay my internet or any bill with it too.
I get in the full time living in the camper in Florida I'll get a gym and if I need to ill get a potable internet set up.
So if this is what your talking about if everything works the way they say it's a good deal.

 

[SuwanneeDave]

In case that photo is too small, here's what it says:

Traditional MEDICARE PLUS a Supplement:

Medicare is a Federal Health Insurance for people 65 or older and some younger people with disabilities

Medicare OPEN ENROLLEMENT is October 15th to December 7th each year.

*YOU & YOUR DOCTOR choose your care
*No Referrals/Authorizations Needed
*ManyDoctors to choose from
*No Lab Fees
*No Pre-Authorizations
*No Hidden Costs
*Many Medigap Plans to choose from that help pay costs Original Medicare doesn't cover, such as copayments, co-insurance, and deductibles
**2023 Medicare Deductible: $226.00

Advantage Plans

-United Healthcare (UHC)
-Anthem (Blue Cross, Blue Shield)
-Cigna, Aetna, Humana, other FOR PROFIT Companies

*Your plan chooses much of your care - NOT YOU & YOUR DOCTOR
*Restrictive Referrals/Authorizations
*Limited Specialists Available
*High Outpatient Fees
*Upfront Copay
*High Out-of-Pocket Costs ($3900-$6700/ year for most plans) for infusion Drugs. Those used for cancer, rheumatology, gastroenterology, neurology, dematology
*CANNOT have a suppliment with these plans.

REMEMBER: If it sounds too good to be true - it is!

I have an Aetna advantage plan and have not found any of those things to be true except for the copay. Plus I get a yearly allowance for dental work and eyeglasses.

 

[Utclmjmpr]

I have been with Humana advantage in Utah for 5 years,,, my county only has two advantage plans available and Humana has been the best of the two.. Seven months ago I lost my wife to cancer,, after 1.3 years of treatment,, two surgeries 15 weeks of Cemo,, Home care for the last three months,, all kinds of in home equipment rentals,, she passed... Total bill,,,565600.00 USD,,, my exposure,,$7900.00..
The average person cannot be un-insured in todays world..>>>Dan

 

[Tulecreeper]

As informative as this thread is, the OP hasn't been back for 3 weeks.

 

[Trivet]

my exposure,,$7900.00..

I'm guessing that's the yearly out-of-pocket maximum on your Advantage plan. Did you hit that maximum? Since the treatment went on for over a year, the out-of-pocket maximum would have reset at some point, which would have made the potential exposure $15,800. Unless you already accounted for the reset.

(The yearly out-of-pocket maximum varies by Advantage plan; the government sets a maximum yearly out-of-pocket maximum for Advantage plans in general, but Advantage plans may offer a lower yearly out-of-pocket maximum if they want to).

So I'm wondering what you actually paid for the entire course of treatment.

 

[Utclmjmpr]

Across 1.5 years = 8600.00 total>>>Dan

 

[Trivet]

Across 1.5 years = 8600.00 total

This is a good example. I think a lot of people would be surprised to learn their $0 premium Advantage plan could actually cost them many thousands of dollars a year. Or, they may know their plan has a $7,900 (in your case) out-of-pocket maximum (MOOP), but would never dream they would actually hit it and certainly haven't socked away that amount of money just in case.

But with cancer treatment in particular, it's highly likely their MOOP will come into play.

Of course they can switch Advantage plans during open enrollment periods ever year, perhaps to get a lower MOOP if they know they're going to be racking up copays and coinsurance. But doing that intelligently will require comparing the details of the coverage offered by the various Advantage plans, plus ensuring a plan's network has their current doctors in it. And they'll still have the uncertainty of whether their current doctors will stay in the network (providers can leave at any time), or whether a new doctor they want to see will be in network (which is literally impossible to predict). And of course they're undergoing cancer treatments all the while.

But somehow all you hear about is the $0 premium, maybe a giveback toward the Part B premium, and extra benefits you qualify for like vision and dental, which also are highly variable among plans.

 

[Tulecreeper]

A month, and still no OP.

 

[Trivet]

A month, and still no OP.

So? He posted to the thread thanking people for their information. Even though nobody actually answered his question.

While I'd love to know what the UHC representative was referring to with respect to the "visitor/traveler add-on" to an Advantage plan, I'm not sure the OP would be the best source of information about that, though, because he asked one poster here what a supplement is, and how it differs from a Medicare Advantage plan. No knock on the OP because this stuff is complicated, and he's new to the game.

So I did a little digging and I think he may be referring to UHC's "Passport" program, which gives plan members access to providers in other UHC Advantage networks in many parts of the country. But it can be used for only nine months at a time, so it's probably not a good choice for fulltimers who travel. Maybe the rep didn't understand the traveling fulltimer lifestyle (as opposed to, say, snowbirds), or maybe the rep was referring to something else and not the Passport program. And it sounds like the OP wasn't versed enough in Medicare to know what questions to ask.

I hope the OP has continued to check in on this thread, because there's been more general information about Medicare and Medicare Advantage posted that he would probably benefit from knowing. But if not, maybe other people have wandered by and learned something.

 

[Utclmjmpr]

In my opinion,, the most important part of ANY plan is your trustworthy agent..>>>Dan

 

[jymbee]

In my opinion,, the most important part of ANY plan is your trustworthy agent..>>>Dan

True, but it can be hard to know, really know what anyone's motivation might actually be:

Medicare agents receive commissions from insurance providers for enrolling beneficiaries in Medicare Advantage and Part D plans. The Centers for Medicare & Medicaid Services (CMS) sets the commissions, which are paid per application and can vary depending on whether the enrollment is initial or a renewal. For example, in most states, the commission for an initial enrollment in a Medicare Advantage plan (MAP) is $611, and the commission for a renewal is $306. For a PDP, the commission for an initial enrollment is $100, and the commission for a renewal is $50.

 

[Trivet]

Agents get commissions on supplements (and supplement renewals), too. Unlike fixed-rate Advantage commissions, supplement commissions are based on a percentage of the premium, and the commissions on supplements are generally (maybe even always?) lower than on Advantage plans.

FWIW, no agent sells every plan available. They're required to disclose that, but I think it's something people don't really think about. It's one thing to go to a Kia dealer and know that all they sell is Kias, and if you want to look at a Toyota, you have to go to a Toyota place. Everybody knows that. But in the Medicare field, you might not even know Toyotas exist.

SHIP counselors provide information about Medicare on a volunteer basis, if paying a commission bothers someone. But even they don't necessarily know everything, and they might still have a bias for or against Advantage plans.

www.shiphelp.org/

Picking one's flavor of Medicare is a minefield. If you have the money, having Original Medicare and a Plan G supplement is the obvious choice--the most comprehensive coverage available with the least hassles.

Well, except you have to pick a supplement company. The good news is that all supplements under the same letter (like Plan G) have the same benefits, and they have no discretion in what they pay toward Medicare claims--if Medicare pays, they pay. So theoretically it doesn't matter which company you choose.

However (there's always a "however" with Medicare), some companies are known to engage in a practice called "closing the book," where they freeze enrollment in a supplement, and open a new supplement with tantalyzing initial premiums, only to repeat the process in a few years. The frozen supplement's premiums go up and up because its membership is all getting older, and there are no younger people offsetting the aging people's increasing claims, and people who can pass underwriting to get another supplement abandon ship.

Granular details like that are not necessarily the province of SHIP counselors, and I'm pretty sure they're not allowed to recommend one company over another anyway. So even if they said, "Now, be careful because some companies have low premiums but they incrase dramatically later when they close the book," what would you do with that information?

Even so, a SHIP counselor would be a good starting point, and their mandate is to offer information, and they don't sell anything.

Again, if you have money, Original Medicare + Plan G Supplement is the way to go, and if you choose the wrong company and end up in a closed book and can't switch supplements, your excellent coverage will continue, only at a higher price.

But if you can't afford OM + G, then you have decisions to make, taking into account money, hassles of getting care, limitations on coverage, comparisons of specific Advantage plan benefits, not to mention predictions of the future. Just what every older person wants to do.

Personally, it was easy for me. I'm a traveling fulltimer and Original Medicare + Plan G supplement covers me wherever I go. Plus it's much cheaper than my insurance when I was under 65, and provides better benefits (my only cost above the premiums is my $240 Part B deductible).

I found a Plan G supplement (AARP/UHC) that includes gym memberships (very common among Advantage plans but relatively rare among supplements), so my choice was clear. I'm very happy to be lucky enough that I can afford it.

(I also have a Part D prescription drug plan, for about $10/month. I don't take any maintenance drugs, so the usual advice on picking a plan doesn't apply to me. And predicting which expensive drugs I might be prescribed for a condition I don't know I will develop is beyond my abilities, so I just got a plan with a low premium.)