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Trusted Contributor

Aetna Medicare or United

I have Aetna and have not had any issues with them but they took OFF my primary doctor and he was the first doctor I actually liked. He said to go for Florida Blue but my orthopedic is NOT on Fl Blue and I have bone on bone both knees and will eventually have to have surgery. Anyone have either plan? Should I look for new primary or try to switch now that open enrollment is happening?

Any help would be greatly appreciated. I do not have any medical issues except for my knees, not on any meds either.    Donna

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Honored Social Butterfly

@DonnaI729360 

 

It most likely was the doctor that decided to stop doing business with the insurance company (Aetna).

 

As with any other health insurance you need to pick the best plan for your needs / wants / pocketbook - remember you can change Medicare Advantage plans every year and should always reassess annually because MA plans change especially in network providers.

 

You will have to set some priorities on your wants for specific doctors or other providers if they aren't all covered.  If you are going to make a change in plans, do it during open enrollment because outside of that annual open enrollment period there are only certain special circumstances which will open up a special open enrollment period.

Medicare.gov - Special circumstances (Special Enrollment Periods) 

 

 

If your MA plan comes with an attached prescription drug plan or if you are looking to change to another that has an attached prescription drug plan, you need to also check that your meds are covered especially any expensive ones.

 

 

 

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Regular Contributor

Sounds like you're on a Medicare Advantage plan. Have you thought about a Medigap plan instead? Especially if you're going to have knee surgery. With Medicare Advantage, you have a MOOP of $6,700. With Medigap, depending on what letter plan you choose, you won't have anything outside your monthly premium and maybe the Part B deductible to pay out of pocket. You also won't have to choose between your doctor and your plan. Unlike Medicare Advantage, Medigap does not have a limited network of doctors. 96% of doctors accept Medicare (different from Medicare Advantage) as long as they accept Medicare, they will accept your Medigap plan too. When it's time for your knee surgery, you won't have to worry about how much cost-sharing you will be responsible for if you have a Medigap plan. You will with a Medicare Advantage plan.  

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@cougarlinz Have you thought about a Medigap plan instead? Especially if you're going to have knee surgery.

 

Impending knee surgery is a KO question. 

 

If the OP wants to leave their MA plan they will have to wait until next open enrollment.

 

Even if they had the surgery before 12/7 the follow up PT will knock them out of consideration for the Medigap plan.


Bark less. Wag more.
Honored Social Butterfly

@cougarlinz 

 

I think you should review Medicare.gov "When Can I Buy Medigap"

 

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You can enroll at any time of the year. You just have to answer health questions if you're outside your OEP. I don't think having knee issues would get them declined. 

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