Medicare and supplemental coverage (San Antonio, Mart: for sale, insurance, private school)

[loves2read]

My sister lives north of SA (78070) and will be going on Medicare in May
she is trying to decide what supplemental insurance plans--either a combined Advantage type or separate health and RX plans might work for her

Just wondered if anyone using this forum was on Medicare with a supplemental plan and if you had suggestions...
She has heart condition and her RX will put her into the donut hole with pretty much any reasonable cost plan

she quit teaching at private school last year and went on Cobra--doing other self-employment work currently--and then dropped Cobra and took out policy through ACA--
she THOUGHT she could keep the same doctors from what the agent who sold her the policy said at lower cost but that was not case--she didn't check w/doctors on their own--
so doesn't want to have same thing happen w/this new supplement

any suggestions for ones to avoid or consider?

[huckster]

No, I have no experience with this.

[need4speed2012]

My parents have always had fantastic service, coverage and pricing using AARP.

[rwr]

Have her check out Humana/Walmart for her Part D ( I pay $15.95/month); and AFLAC for her Part F( I pay $135.00/month).

[steve807]

Last year I opted for the no cost Humana Medicare advantage (you still pay the Part B $104 monthly to the gov). You choose one of their primary care docs who must refer you to any specialists. And the referral and approval to pay gets fouled up more often than not.

This year I bumped it up a notch to the Humana advantage plan that costs ~$65/month (still paying the Part B $104 to the gov) which lets you go to any specialist without a referral, Humana network docs are cheaper (but all co-pays are much higher and all other out of pocket costs for hospital rooms, annual out-of-pocket, etc are higher). Both these plans have the same (decent) Rx coverage.

Anyway in your sister's case be sure you can do what you are planning - the normal enrollment window is closed now. Certain special cases will allow you to enroll outside the window (like retirement or moving away).

My friend has an ACA plan, not the bottom one, it is a step or two higher up, and has had a devil of a time finding a cardiologist to take it. Thats with her paying $400 / month and the gov kicking in a similar sized supplement. Some docs are posting signs that they accept NO ACA plans, no matter which one.

This stuff has become royally fouled up.

[loves2read]

Thanks for the last couple of replies--those specifics were what I was hoping for--
are you based in San Antonio TX area?
I should have said COMAL CO--that is where she is--78070
My sister turns 65 in May so she can enroll up to 3 mo before and start May 1

[wehotex]

Originally Posted by rwr

Have her check out Humana/Walmart for her Part D ( I pay $15.95/month); and AFLAC for her Part F( I pay $135.00/month).

The value from that Part D plan works best when you have a Wal-Mart or Sams near you since they are "preferred" pharmacies. Otherwise, the standard $325 annual deductible would apply. AFLAC is not really known for their Med Supp policies. The sister is turning 65. Less expensive Med supps would most likely be available. Some San Antonio med advantage plans have preferred cardiology groups as well. If that's important to her, it's best to ask the cardiologist's billing office which Med Advantages plan they are contracted with.

[loves2read]

She has a WalMart close enough
and I have suggested that she checks with the old cardiologist who refused to take her ACA policy as to which MediGap or others they might take

[fajitanumerouno]

If your sister is concerned about reaching the donut hole then please be sure to carefully review the low price WalMart/Humana plans. Costs in the donut hole may be higher in the very low premium plan then a plan with a higher monthly premium. So could be to her disadvantage. Some of the lower premium plans are very good if you don't take a lot of regular or expensive medication but then if you reach the donut hole the charges are higher and might outweigh paying a higher monthly premium. She needs to consider this carefully. I believe if you call Humana they can do a cost comparison by plan for you or they have an online tool to calculate and compare.

Medigap plans work with any Dr. who takes medicare, the Medicare Advantage plans (HMO/PPO type plans) have their own networks. Be sure to call or check the Drs. she wants to see are in the network if she goes with an MA plan.
Medigap plans F and N are most popular and comprehensive but be clear there is no RX coverage in any Medigap plans bought today (years ago there was, they are no longer available for sale by any co). MA plans typically include RX coverage and depending on monthly premium will have different coverage (to the extent they can) in the donut hole. Good thing she is researching now.

[loryde]

The problem with Medicare supplement policies is finding doctors willing to treat you. Such plans are also expensive. I was paying about $270 a month, in addition to the Part B premium, for such coverage, including a separate drug plan with Humana. I switched to an Aetna Medicare Advantage PPO plan a year ago, which reduced my premium to about $70 a month. (I decided those "no premium" plans might represent a false economy.) The "preferred provider" networks seem quite broad. I see they list 137 cardiologists in Bexar County.

I doubt anyone is going to offer you any real relief from the "donut hole."