Best $0 Premium Medicare Advantage Plan (Myrtle Beach: pharmacy, pros and cons, deductible)

[Kaisermust]

Soon to be relocating to MB area. Looking for recommendations for SPECIFIC $0 Premium monthly cost Medicare advantage plans and the pros and cons of such. Personal experience with your recommendation would be appreciated. We have excellent $0 cost plan here in upstate NY (local, most Drs-GP’s and Specialists participate in it-it’s an HMO- it covers most everything with low cost reasonable co-pays for doctor visits, hospital stays etc. There are 3 Humana plans I’ve seen for Horry County which are supposedly rated very high (4 stars or more out of 5) but we have no experience with Humana here in NY.

[Bamaman1]

The Advantage plan I understand works much like a HMO. A doctor's group is paid "$X" a month to manage your case no matter how many times they have to see you. Often, seeing a patient may not be profitable to the doctor's group, and you may not be given the best quality of care.

There is a very dominant hospital chain close to us that has purchased hundreds of doctors' offices and they refuse to allow their offices and their 1,700 doctors and nurse practitioners to accept Medicare Advantage plans. This has made the doctors' old, established patients to have to switch doctors and even go to different hospitals often a county or two away. This is not good.

My wife has bad arthritis and spinal stenosis--and has had numerous surgeries in the last year. Plan G Medicare is expensive, but the level of care is so superior. We are also able to go to the absolutely top specialists in our area and make our own healthcare decisions. We've had a HMO in the past, and do not care to have to play their games again.

[salonva]

We are in another state, with an Advantage Plan (also $0 pay). I am curious to see the answers you will get because it really does vary location (or at least county by county for sure). There are some that really don't have many particpating doctors and others, that with research, you find have most of the top rated mds in the area.
Very wise to be checking this out now. I hope you get good feedback.

[CTyankee54]

There are many Advantage plans to choose from as I'm sure you know and the "best" one is the one that meets your health needs since everyone's health differs.



We are in relatively good health and have few medical needs other than annual exams, dental, eye exams and an occasional specialist. Because our doctor visits are on the low side, we also prefer to pay a reasonable copay and keep premiums low ($0) rather than have zero copay and pay a higher premiums. We live in Myrtle Beach and because we travel within the US, we did not want an HMO style plan but preferred a PPO so we chose Humana H216-156. It is a $0 premium plan with an in-network deductible of $6,700. Within network, primary care carries a $5 copay and specialist $45 copay. Preventative care (annual checkup) has no copay. In network lab is $0 copay.



We like this plan because it also has a basic dental plan and pays $100 toward glasses each year.



My wife had some minor outpatient surgery this year and, while I can't remember the exact cost, our out of pocket was less than $1000. We thought it was very reasonable.



You can also order your prescriptions through Humana's mail order pharmacy for reduced cost. I have a couple of prescriptions that I take and when I was getting them at CVS, I was paying about $60/quarter for them. I switched to mail order and have a $0 copay...so they cost me nothing out of pocket instead of $240/year. My wife prefers to deal with the local pharmacy so she still gets hers through CVS and pays the copay. There is, of course, a formulary and tiered drugs but that's normal with any plan.


Another minor perk with the plan is that Humana gives you $25 per quarter to spend on over the counter medications, etc. though their online web site. I've gotten a emergency kit for my car, bug spray, sun screen, a thermometer, toothpaste and other assorted items for free (they don't even charge shipping). It's not a big benefit, but it's a nice perk.



Humana seems to have a pretty robust network in the area. All of our doctors (including specialists) are in their network. Of course, other users may have a different experience.



We've had this Humana plan for a couple of years and I can't really think of many cons but, of course, we are not heavy health care users at this point in our lives. That will change as we grow older. The main con that I've seen so far is that their web site is a little slow and not very well designed. But, I felt the same way about Aetna's web site when we had coverage through them. Other than that, we've been very pleased with this plan.

[SPARKY12]

Beware of advantage plans. Recently my relative needed surgery, it was too complicated for the grand strand hospital to do, they told her to go to musc in charleston. they are out of network, so they have to pay $6500. Also musc has dropped blue cross and another major carrier advantage plan. Her health used to be good, now it's not, everytime she sees a doctor there's a $45 co pay and she's been seeing lots of doctors. You never know when you will need to see the doctor or hospital of your choice.

[snuffybear]

Do doctors around there take United Healthcare?

[CTyankee54]

My Mom was on United's Medicare Advantage plan and did not have any trouble finding a doctor. But, every physician practice is different so you would need to check their online participating physicians list to see if any particular one takes United. Generally, though, United is accepted pretty widely.