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Periodic Contributor

Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Hi,
AARP's Medicare Supplemental Medicare Insurance sounds great... but I decided that before I purchase it I should read the reviews.

I was astounded!

 

Consumer affairs reviews were the worst I have EVER seen for any product or service from any company. People were talking about outright misrepresentation of services, copays, non-existent customer service. Representatives simply hanging up on customers, drug formularies not covering many common medications. Increasing co-pays. A litany of misrepresentation and worse.


Now I understand the Internet. You will always find people more willing to badmouth a product or service than to praise it... but I looked for positive reviews and found none...

 

http://www.consumeraffairs.com/insurance/aarp_medicare.html

 

Is it really this bad? If so why does AARP tolerate this if they are, as they claim, an organization that exists to promote the best interests of senior citizens?

 

Have I simply been looking for reviews of AARP United Healthcare supplemental insurance in the wrong places?

 

Can anyone here describe their own experience with this insurance? I live in California... but will be moving to Arizona...

 

If not AARP/UHC insurance, can anyone here recommend a company for Medicare supplemental insurance with which they have had a positive experience?

 

Thanks

 

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Regular Contributor

A couple of months ago, I had two issues to address--get a new AARP card mailed and a United Healthcare Part D Supplement ID. I went ahead and printed the online card while waiting, which had the same membership number printed on my AARP Chase Visa Rewards credit card, but when the mail arrived I had a new AARP membership number. I called United Healthcare and was informed that my old number was now my Part D Supplement insurance policy number, so I orderwd an ID card for that over the phone. Now I get loads of junk mail asking if I would like to try and qualify for a United Healthcare policy wveryday, but no insurance supplement card to go with the Medicare card I have had since August of 1989.

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Periodic Contributor

I am a 69 year old female and live in Ohio.  I have been on the United Healthcare Supplelmental Plan F insurance since I turned 65.   I have been completely happy with the plan and have not had any problems what so ever.   I like the plan because there is no paperwork involved, I can go to any doctor and hospital I want without any referrals, the customer service has been good, my doctors always get paid with no problems, and it is the most convenient of all the plans.  I have my monthly insurance fee paid electronically, so I rarely need to give my medical insurance a second thought.     I suggest you read all the information regarding all plans to educate yourself on making the best choice for you.  Their website provides lot of useful information and comparison charts.   The Supplemental Plan F is probably the most expensive, but I feel it is worth it for all the options and convenience factors.   I cannot respond to problems others have had -- this feedback is only based upon my own experience for the past 4 years.  

Good luck to you. 

Contributor

My wife and I have had the Plan F Supplemental coverage via AARP/UHC for two years. We are very happy with the plan.  We have no co-pays.  However, be advised that the plan cost has increased 7.5% per year since we signed on.  We started out at $265 a month and now we are at $306 a month.  I created a spreadsheet projecting a 7.5% cost increase over the next 20 years and there is definitely a point where the coverage will no longer be affordable and it looks for us like it will be when we are in our mid-70's.

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Regular Contributor

Did you figure in that after age 75 the price increases drop in HALF?
Contributor

You've commented 5 times in one day and 4 more times in March... calm down! You're flooding other commenters inbox. 

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My mom had the same issue and brought it to my attention. After doing some research I found a good website that provided useful information and other options that would give her the same coverage and reduce the cost. I found out that Plan F is going away soon and that Plan G would be the best alternative... so keep that in mind as well. Here is some info I found on Plan G... 

 

https://www.medicarefaq.com/medicare-supplement/plan-g/

Melissa Kay
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Plan F is going away ONLY for those that are new enrollees after 2020. If you have Plan F now, or are eligible for it now, you can have it and keep it FOREVER. IT WILL NOT BE TAKEN AWAY FROM YOU!!!
Honored Social Butterfly


@jm590797 wrote:

My wife and I have had the Plan F Supplemental coverage via AARP/UHC for two years. We are very happy with the plan.  We have no co-pays.  However, be advised that the plan cost has increased 7.5% per year since we signed on.  We started out at $265 a month and now we are at $306 a month.  I created a spreadsheet projecting a 7.5% cost increase over the next 20 years and there is definitely a point where the coverage will no longer be affordable and it looks for us like it will be when we are in our mid-70's.


Supplemental Medicare plans are governed by the federal government AND the state in which you live. The rating structure is based upon the way your state has decided to do it.  It could be age related, community based, etc.  So before you determine fault for rate increases, then you need to determine how your state has legislated for these plans to be structured.

Here are are some informational links -

 

https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html

 

http://www.ehealthmedicare.com/medicare-supplement/issue-age-pricing/

 

Any other increase, as most other insurance plans, has to be approved by your insurance commissioner if it is over some stated threshold.

 

 Plan F is one of the most expensive supplemental plans, if not the most expensive.  This is because it covers just about everything that Medicare does not pay with NO out of pocket on your part, in fact it even covers your deductible.  

 

This is type of plan may well go the way of the dinosaurs and not to far into the future because one of the ways to help control healthcare cost is to have the beneficiaries have at least some out of pocket.  The current Administration has already suggested this several times and it seems to be in the investigational works.

If you want to keep this type of coverage, you have to stay enrolled and pay your premiums.  For others just signing up, someday these type plans might not be available at all.

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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The rate increases drop in half at age 75.  You get a 30% discount off the standard rate at age 65 and lose 3% of the discount per year till age 75 when you ONLY get inflation rate increases.  They do NOT raise the premiums because of age.  They are the ONLY carrier that does community rating.  Everyone of every age gets the same rate.  PLUS, they are the ONLY carrier that will let you change plan levels any time of year instead of only once a year in Open Enrollment (that is the only time other carriers let you change).  In July, they will have a plan G which will be cheaper and they have always had a Plan N.  SO...if $306 is too expensive for 2 people, one or both of you can pick up the phone and say "I want to go to Plan N."  At the first of the next month, they will have you on a plan N*.  Then 2 months later you are planning a hip replacement, you call them "I want to go back to plan F (full coverage)".  The first of the next month, you are on Plan F.  You CAN control costs better than with ANY other company.  *be aware that any plan other than Plan F means you have to pay deductibles and maybe coinsurance too and that could cost more out of pocket than just staying on Plan F...especially if you have a heart attack ($147,000 for a friend of mine 5 days in the hospital).

Trusted Contributor

Without getting into the positive or negative reviews of the AARP/UHC medicare supplement plan F, it is interesting to note that this is one of the most expensive Plan F offerings out there. How come AARP, perhaps the largest organizations out there (excepting the various governments and government agencies), can't negotiate a better deal with UHC?

For example, including the somewhat odd decreasing "discount" applied over the first decade, and not accounting for any group rate increases over the next 25 years, the premiums alone would amount to over $60,000 during this time! Compare this to, say, the Old Surety Insurance Company's plan F which would cost approx $39,000 for the same coverage over the same time period. Note that this is an "issue age" policy which, unlike an "attained age" policy, is comparable to AARP/UHC's "no-age" policy.

I don't see much benefit to being a member of AARP and blindly purchasing their medigap policy because their stated mission is to look after seniors' best interests. Can someone perhaps help me understand why I should even bother with the AARP membership and benefits when one of their primary products/services appears to be one of the least competitive in the market?
Regular Contributor

No, it is NOT one of the most expensive plans out there.  You have not shopped well.  I have.  It is not the cheapest but it is on the lower end of the plans in cost and every plan cheaper was from companies that had very high rate increases after the first 3 years or were financially unstable or had questionable ethics.  AARP is stable, predictable and by age 75 IS one of the cheapest. 

Honored Social Butterfly

@sktn77a

 

A link for you 

How to compare Medigap policies from Medicare.gov

 

Federal and state laws govern Medigap policies.

If Plan F is available in your state, all Plan F's must cover the same Medicare benefits - shown in the Medicare.gov link.

So if you are only looking for these benefits, don't get confused by one insurer being more famous than another.

 

I always thought that state law regulates how Medigap policies are rated and thus all in your state would use the same rating method - community rated / age related, etc.

 

 

It's Always Something . . . . Roseanna Roseannadanna
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The federal government says they all must cover the same things BUT it does NOT say that they can't increase their premiums through the roof once you are enrolled. Almost all other carriers increase your premium every year you get older FOREVER. AARP only increases premiums on every person of every age in over 100+ zip codes. So you can get to be 90 and pay the same as the 70 year old down the street in your area.
Trusted Contributor

Thanks Gail1.  Yes, I'm familiar with that.  North Carolina has all three different rated policies so you have to be careful you're comparing apples to apples.  My concern, however was that AARP endorses only one policy and it is one of the most expensive.  Given that all Plan F policies must provide identica coverage, I can't figure out why the AARP-endorsed policy is so expensive?

 

Unless.......................

Regular Contributor

AARP plans are NOT the most expensive. I ran a cost comparison for Plan F with all the carriers in my area. Only 3 were less expensive and they offered far fewer benefits and much HIGHER rate increases in the coming years when the AARP plans were lowering their rate increases in the coming years.
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Periodic Contributor

Supplement Benefits for each letter are Federal Regulated and all the Same. Customer Service can vary but that is it. In my area AARP is 20-30% higher than most plans. AARP also says that their rate is 30% discount at 65. Then it will increase 3% each year for 10 years plus they add yearly 'inflation' rate hikes on top of that. My Mom is paying 200 for AARP plan F at age 75 plus 134 for part B. AARP plan has never paid out more than 500 in any year since she was 65 some years less than 100. It is the drugs that devastate Seniors financially. For AARP plan to pay out more than Premiums in 1 year would take devastating illness or accident and even then maybe only 1 or 2k over premium.
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Your can consider herself lucky as snce I have had plan F I have been in the hospital 3 times (ovenight) for fainting spells, suffered a total broken arm with over $100,000 worth of hosptial bills and Never ( Say Never) saw one bill!!! The stays in the hospitals were over $7,000 each time and I am only 68 years old!! Plan F is great but for others there is also a plan G that is a little cheaper but doesn't cover a basic Medicare deductble (where F does)

Now not all states provide the discount at 65 and then the upcharges as noted for 10 years. I know NJ and PA do but some other states just have flat rates depending on your age, so that is something one needs to consider as to where they live.

Yes there are cheaper plans but yes they are All Federally governed with similar rates nationwide. But the beauty is that you can go to any doctor or hospital that accepts Medicare Nationwide and into Canada whreas much much cheaper plans like Medciare Advantage plans have networks regionally (like HMO's) and are very very very expensive if you go out of the network or need to travel and get sick!

 

Periodic Contributor

Stop scaring others with your lack of understanding or is it  you are an Insurance sales person?Let someone show proof that Medicare payed these grossly over priced bills when the conditions and Surgery mentioned don't warrant price Insurance and Medicare pay for those services. If you never saw a Bill how do you know what Medicare actually paid? Please research how all this billing works before you scare your fellow seniors into paying there needed income on large  premiums[ maybe unessasaraly] and keeping Insurance Industry Filthy rich. I am not saying if it's afforable for someone and they just want security of never paying anything ever fine go for it. But knowledge is Power AND finding out the reality of 'What is Billed and What is actually paid' is something that needs to come to light so we can all make a Educated not Fear based decision

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PS ; This is excerpt from link below

The first bill is for a patient who spent two days in the hospital, and has private insurance (a Medicare advantage program). Let’s see how the numbers add up. In the bottom right corner is the Account Summary. From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.)

On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of the total due! Ouch! Doesn’t that leave the patient on the hook for the remaining $19,172.54 (still about $10,000/day, which would be a little hard on most of us)? No, because the next line is the insurance Adjustment, which is the amount that the insurance company miraculously convinces the hospital to forgive. In the end, the hospital charges twenty-one thousand dollars, the insurance company pays two thousand dollars, the patient pays fifty dollars (that’s right, just $50) and the rest just goes away.

http://truecostofhealthcare.org/hospitalization/
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Newbie

Every Plan F must offer exactly the same benefits. So, the ONLY difference is the premium.

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Honored Social Butterfly

What I want to find out is where  can I see the questioner that you have to answer when you apply for a Medicare Supplemental plan. To  be able to see illegibility to a Supplemental program? any ideas? have bee looking in the Internet and cannot find anything that I can see on this issue.

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Honored Social Butterfly


@Roxanna35 wrote:

What I want to find out is where  can I see the questioner that you have to answer when you apply for a Medicare Supplemental plan. To  be able to see illegibility to a Supplemental program? any ideas? have bee looking in the Internet and cannot find anything that I can see on this issue.


Suggest you see a local expert on the subject then talk to your Insurance Agent. You will not get complete advice from anyone in here.

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@Roxanna35 wrote:

What I want to find out is where  can I see the questioner that you have to answer when you apply for a Medicare Supplemental plan. To  be able to see illegibility to a Supplemental program? any ideas? have bee looking in the Internet and cannot find anything that I can see on this issue.


Medigap coverage is ONLY supplemental coverage to Medicare.

 

It is sold by private insurance companies and thus unless you buy it when you have (Medicare ruled) GUARANTEED ISSUE RIGHTS, they don't have to sell it to you.  PERIOD.

 

They can choose to deny you.

They can choose to underwrite you.

They can choose to underwrite you, approve you and charge you more.

They can choose to underwrite you, approve you, charge you more and not cover any pre-existing condition for a set time period.

 

UNLESS you have Medicare-ruled GUARANTEED ISSUE RIGHTS, it is up to the individual health insurer as to what they want to do with you - yea/nay/or with price and other conditions.

 

If you are thinking this is similar to the ACA in denying you because of a pre-existing condition - think again, because MEDIGAP coverage is NOT full insurance, in fact, it is not even health insurance - It is supplemental coverage to original Medicare.

 

I am assuming that you told your agent that you wanted to change your coverage to original Medicare but ONLY IF you could get approved for a supplemental Medigap plan, knowing beforehand what price and conditions you might have to abide, if approved at all.

 

You have the right to go back to original Medicare if you want because that is just another choice in how you want to receive your benefit.  A Medigap policy is outside of this realm of coverage because it is supplemental, meaning something extra.  

Original Medicare = Medicare Advantage, they are one in the same.  Medigap is NOT, it is something extra.

 

 Medicare.gov - When can I buy a Medigap ?

 

The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you're 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more.

 

. . . . Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.

 

. . . . If you apply for Medigap coverage after your open enrollment period, there's no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you're eligible due to one of the situations below. (See the above link)

 

. . . . During the Medigap open enrollment period, an insurance company can't use medical underwriting. This means the company can't do any of these things because of your health problems:

Refuse to sell you any Medigap policy it sells
Make you wait for coverage to start (except as explained below)
Charge you more for a Medigap policy

 

In some cases, an insurance company must sell you a Medigap policy, even if you have health problems. You're guaranteed the right to buy a Medigap policy:

When you're in your Medigap open enrollment period
If you have a guaranteed issue right
You may also buy a Medigap policy at other times, but the insurance company can deny you a Medigap policy based on your health.

 

. . . . If you buy a Medigap policy when you have a guaranteed issue right (also called "Medigap protections"), the insurance company can't use a pre-existing condition waiting period.

 

. . . . The insurance company can't make you wait for your coverage to start, but it may be able to make you wait for coverage if you have a pre-existing condition.

In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months (called the "pre-existing condition waiting period"). After these 6 months, the Medigap policy will cover your pre-existing condition.

 

Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.

 

When you get Medicare-covered services, Original Medicare will still cover the condition, even if the Medigap policy won't cover your out-of-pocket costs, but you're responsible for the coinsurance or copayment.

 

I have already given you the link to Medicare - Guaranteed Issue Rights -

 

To answer your question, a Medigap insurer, if you do not have guaranteed issue rights, can ask you detailed questions on your health conditon(s).  And they can make their own decisions about whether or not to cover you at all or with stipulations in price, may cost more, and in coverage for a specified amount of time.  It is up to them if you do not have guaranteed issue rights or Medigap Protections.

 

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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Gail!!!!!!!  I just want to see the eligibility questions. for a Supplemental. or are they secret to the general public?  just the questions Gail  just the questions.? 

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@Roxanna35 wrote:

Gail!!!!!!!  I just want to see the eligibility questions. for a Supplemental. or are they secret to the general public?  just the questions Gail  just the questions.? 


MORE info - from General information on various insurance agents websites about Medigap application process in various states where they write Medigap policies -

 

Boomer Benefits - Can I Pass Medigap Underwriting To Change My Supplemental Plan?

 

An old (2011) instructions PDF to their company agents writing Medigap policies 

NOTE:  all private companies that write Medigap policies can use their own underwriting criteria if that be the case.  Only in those cases stipulated by Medicare (CMS) when NO underwriting or denial is permissible do they HAVE to write or deny a supplemental policy with no strings attached - meaning that a person is within the Medigap Open Enrollment period or have Medigap protection or Guaranteed Issue Rights.

 

2011 CSI - Agent Underwriting Guidelines for Medicare Supplemental Policies

 

Just a few examples of when and how your info can be asked and used.

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 wrote:

@Roxanna35 wrote:

 


MORE info - from General information on various insurance agents websites about Medigap application process in various states where they write Medigap policies -

 

Boomer Benefits - Can I Pass Medigap Underwriting To Change My Supplemental Plan?

 

An old (2011) instructions PDF to their company agents writing Medigap policies 

NOTE:  all private companies that write Medigap policies can use their own underwriting criteria if that be the case.  Only in those cases stipulated by Medicare (CMS) when NO underwriting or denial is permissible do they HAVE to write or deny a supplemental policy with no strings attached - meaning that a person is within the Medigap Open Enrollment period or have Medigap protection or Guaranteed Issue Rights.

 

2011 CSI - Agent Underwriting Guidelines for Medicare Supplemental Policies

 

Just a few examples of when and how your info can be asked and used.

 

 

Gail, thank yo so much for those two links. I read and re read than to make sure that I understood what they said. and this is what i came out with.

First of all, Macular Degeneration is not mentioned anywhere in the list of  disease that may disqualify you. at all. 
I happen to use Avastin. and saw that Avastin has other uses besides Macualar degeneration.
The only thing that I could have that could disqualifies me is that I receive those injections at the Dr's office. 
Right now, My doctor is considering extending the time that I receive those injections because there has not  been any progression for almost two years. On top of all of this I receive help with the cost of these injections which for Avastin is not very much. from a Foundation that helps me.
The other link is what I am referring to. I will go to them and see what they can do. because, I do believe that the way in which they generalize the fact that you receive  injections is a disqualified is something that they need to really become more specific.
so that is my next step. and then Medicare will be my last resort.  

 

 


 

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@Roxanna35 wrote:

@GailL1 wrote:

@Roxanna35 wrote:

 


MORE info - from General information on various insurance agents websites about Medigap application process in various states where they write Medigap policies -

 

Boomer Benefits - Can I Pass Medigap Underwriting To Change My Supplemental Plan?

 

An old (2011) instructions PDF to their company agents writing Medigap policies 

NOTE:  all private companies that write Medigap policies can use their own underwriting criteria if that be the case.  Only in those cases stipulated by Medicare (CMS) when NO underwriting or denial is permissible do they HAVE to write or deny a supplemental policy with no strings attached - meaning that a person is within the Medigap Open Enrollment period or have Medigap protection or Guaranteed Issue Rights.

 

2011 CSI - Agent Underwriting Guidelines for Medicare Supplemental Policies

 

Just a few examples of when and how your info can be asked and used.

 

 

Gail, thank yo so much for those two links. I read and re read than to make sure that I understood what they said. and this is what i came out with.

First of all, Macular Degeneration is not mentioned anywhere in the list of  disease that may disqualify you. at all. 
I happen to use Avastin. and saw that Avastin has other uses besides Macualar degeneration.
The only thing that I could have that could disqualifies me is that I receive those injections at the Dr's office. 
Right now, My doctor is considering extending the time that I receive those injections because there has not  been any progression for almost two years. On top of all of this I receive help with the cost of these injections which for Avastin is not very much. from a Foundation that helps me.
The other link is what I am referring to. I will go to them and see what they can do. because, I do believe that the way in which they generalize the fact that you receive  injections is a disqualified is something that they need to really become more specific.
so that is my next step. and then Medicare will be my last resort.  

 

 


 


Like I said in my post - these are just some examples - one is old (2011)

These are PRIVATE insurers offering this SUPPLEMENTAL coverage to Medicare.  EACH one can made their own risk rules about any condition.

 

AMD is an expensive disease to treat and there is no actual cure.  I believe since the treatment is done in the doc's office under original Medicare, it is covered by Part B if a person has ORIGINAL Medicare so maybe the supplemental insurers see a heightened $$$$ risk for them - I don't know, just a guess.  

 

Please se understand that these are just examples - insurers in this SUPPLEMENTAL market evaluate their OWN risk individually - they are not all the same.  I gave you this example only for you to see how the rules are developed by each company individually.

 

I don't even think this insurer writes Medigap policies in Florida.

 

Again I tell you - Nobody can deny you Medicare benefits.

original Medicare = Medicare Advantage - they are one in the same just different ways of covering the SAME benefits.

 

Supplemental coverage or Medigap is not health insurance, it is supplemental coverage and thus does not have to be offered to anybody outside of the times when it cannot be denied for pre-existing coverage or premium level.

- during the Medigap open enrollment period and

- during specified times when "guaranteed issue" as listed by original Medicare is in play.

I don't believe any of these apply to you and your situation.

 

You do not get a supplemental policy before picking up original Medicare.

You can only buy supplemental coverage from the insurers that offer it in your state.  They have the right to deny you or approve you with underwriting and most likely charge you more or even underwrite you, charge you more and hold off coverage on a pre-existing condition for a specific amount of time.

 

why don't you get some clarification from SHINE (FL SHIP) or even from the FL Dept. of Insurance.

 

Florida Dept of Consumer Affairs - Medicare Supplement Insurance Overview

 

Florida Office of Insurance Regulation - Medigap

notice the "important information"

 

Florida Office of Insurance Regulation - SAMPLE Medicare Supplement Rates by County

 

This last one gives the insurers that write Medigap policies in Florida by county.  Remember even if one of them decides to underwrite you, your premiums might be much higher and they may also disqualify your pre-existing condition(s) for a specified amount of time.

 

You are not promised access to a supplemental policy - it is something extra available to those who meet the timing and other criteria.  

 

A question - would you still want a supplemental policy if the insurer wanted to charge you $500 or more per month for it and perhaps not cover your pre-existing condition for 6-months?  

 

Do you want original Medicare in place of a Medicare Advantage plan?

That might be original Medicare WITHOUT a supplemental policy or perhaps one if you are underwritten by a Medigap insurer that might cost you a very heafty premium each month.

 

Added:  How Macular Degeneration is covered under ORIGINAL Medicare

Medicare.gov - Macular Degeneration Original Medicare coverage

 

I think  if it were me, I would think about this very hard.

 

 

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 wrote:

@Roxanna35 wrote:


 


Like I said in my post - these are just some examples - one is old (2011)

These are PRIVATE insurers offering this SUPPLEMENTAL coverage to Medicare.  EACH one can made their own risk rules about any condition.

 

AMD is an expensive disease to treat and there is no actual cure.  I believe since the treatment is done in the doc's office under original Medicare, it is covered by Part B if a person has ORIGINAL Medicare so maybe the supplemental insurers see a heightened $$$$ risk for them - I don't know, just a guess.  

 

Please se understand that these are just examples - insurers in this SUPPLEMENTAL market evaluate their OWN risk individually - they are not all the same.  I gave you this example only for you to see how the rules are developed by each company individually.

 

I don't even think this insurer writes Medigap policies in Florida.

 

Again I tell you - Nobody can deny you Medicare benefits.

original Medicare = Medicare Advantage - they are one in the same just different ways of covering the SAME benefits.

 

Supplemental coverage or Medigap is not health insurance, it is supplemental coverage and thus does not have to be offered to anybody outside of the times when it cannot be denied for pre-existing coverage or premium level.

- during the Medigap open enrollment period and

- during specified times when "guaranteed issue" as listed by original Medicare is in play.

I don't believe any of these apply to you and your situation.

 

You do not get a supplemental policy before picking up original Medicare.

You can only buy supplemental coverage from the insurers that offer it in your state.  They have the right to deny you or approve you with underwriting and most likely charge you more or even underwrite you, charge you more and hold off coverage on a pre-existing condition for a specific amount of time.

 

why don't you get some clarification from SHINE (FL SHIP) or even from the FL Dept. of Insurance.

 

Florida Dept of Consumer Affairs - Medicare Supplement Insurance Overview

 

Florida Office of Insurance Regulation - Medigap

notice the "important information"

 

Florida Office of Insurance Regulation - SAMPLE Medicare Supplement Rates by County

 

This last one gives the insurers that write Medigap policies in Florida by county.  Remember even if one of them decides to underwrite you, your premiums might be much higher and they may also disqualify your pre-existing condition(s) for a specified amount of time.

 

You are not promised access to a supplemental policy - it is something extra available to those who meet the timing and other criteria.  

 

A question - would you still want a supplemental policy if the insurer wanted to charge you $500 or more per month for it and perhaps not cover your pre-existing condition for 6-months?  

 

Do you want original Medicare in place of a Medicare Advantage plan?

That might be original Medicare WITHOUT a supplemental policy or perhaps one if you are underwritten by a Medigap insurer that might cost you a very heafty premium each month.

 

Added:  How Macular Degeneration is covered under ORIGINAL Medicare

Medicare.gov - Macular Degeneration Original Medicare coverage

 

I think  if it were me, I would think about this very hard.

 

 


Gail  perhaps I have been lucky. Avastin cost is about 400.00 per injection and in my case most of it is provided by the Foundation. I do know that the other injections are a lot more expensive but, let's face it ,the injections are the only treatment for Macular Degeneration.  Most of the people that do have this disease have also Pharmaceuticals that provide the injections at no cost if you qualify.
And if you are considered that this problem has been contained. What is the cost? I don't know as to why you consider the treatment that expensive. or any more expensive that people with Cancer, and other really very serious disease. Please do clarify as to why you consider this disease expensive? Tje most expensive treatmen are the injections and they are not done that often in most cases.

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@Roxanna35 wrote:


 


Gail  perhaps I have been lucky. Avastin cost is about 400.00 per injection and in my case most of it is provided by the Foundation. I do know that the other injections are a lot more expensive but, let's face it ,the injections are the only treatment for Macular Degeneration.  Most of the people that do have this disease have also Pharmaceuticals that provide the injections at no cost if you qualify.
And if you are considered that this problem has been contained. What is the cost? I don't know as to why you consider the treatment that expensive. or any more expensive that people with Cancer, and other really very serious disease. Please do clarify as to why you consider this disease expensive? Tje most expensive treatmen are the injections and they are not done that often in most cases.


To tell you the truth, rker321, I do not know what Medicare's (CMS) current stand is on the use of Avastin for AMD - it is being used "off label" - we have talked about this before.  Avastin has been proven to be a good way to treat AMD.  Yes, it is much cheaper than Lucentis or Eylea but it is still being used "off label". But yes, tremendously cheaper.

 

Here are the latest things I could find.

MedScape: 06/17/2014 - Switch From Lucentis to Avastin Could Save Medicare $18B

 

Previous research indicates that the 2 medicines have similar efficacy and safety profiles. The biggest difference is a $2023 per dose price tag for ranibizumab (Lucentis), which is approved by the US Food and Drug Administration (FDA) for both ocular conditions, compared with about $55 for a dose of bevacizumab (Avastin), which lacks federal approval for such uses. (that's the reason it is used off-label)

 

USA Today 04/24/2014 - Some top Medicare beneficiaries spend heavily to lobby

 

Medicare paid more than $956 million in 2012 to Genentech for Lucentis, more than any other drug — even as many retina specialists, backed by a two-year federal study — say that Avastin, another drug produced by the company approved to treat cancer, is as effective as Lucentis at treating the eye disorder. The disease is a leading cause of blindness in people older than 60.

 

Lucentis costs nearly $2,000 per injection; Avastin, about $50.

 

Are you getting help from the charitable arm of Genentech to pay for the Avastin?

 

I am sure that original Medicare does cover it under Part B but all of it, since it has to be recompounded, I don't know.  - ask your doctor.

Doesn't that $ 400 cover the cost for the office visit and the doc's time?

 

Just another question to ask and compare the coverage of original Medicare to your Medicare Advantage plan.

 

 

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 wrote:


To tell you the truth, rker321, I do not know what Medicare's (CMS) current stand is on the use of Avastin for AMD - it is being used "off label" - we have talked about this before.  Avastin has been proven to be a good way to treat AMD.  Yes, it is much cheaper than Lucentis or Eylea but it is still being used "off label". But yes, tremendously cheaper.

 

Here are the latest things I could find.

MedScape: 06/17/2014 - Switch From Lucentis to Avastin Could Save Medicare $18B

 

Previous research indicates that the 2 medicines have similar efficacy and safety profiles. The biggest difference is a $2023 per dose price tag for ranibizumab (Lucentis), which is approved by the US Food and Drug Administration (FDA) for both ocular conditions, compared with about $55 for a dose of bevacizumab (Avastin), which lacks federal approval for such uses. (that's the reason it is used off-label)

 

USA Today 04/24/2014 - Some top Medicare beneficiaries spend heavily to lobby

 

Medicare paid more than $956 million in 2012 to Genentech for Lucentis, more than any other drug — even as many retina specialists, backed by a two-year federal study — say that Avastin, another drug produced by the company approved to treat cancer, is as effective as Lucentis at treating the eye disorder. The disease is a leading cause of blindness in people older than 60.

 

Lucentis costs nearly $2,000 per injection; Avastin, about $50.

 

Are you getting help from the charitable arm of Genentech to pay for the Avastin?

 

I am sure that original Medicare does cover it under Part B but all of it, since it has to be recompounded, I don't know.  - ask your doctor.

Doesn't that $ 400 cover the cost for the office visit and the doc's time?

 

Just another question to ask and compare the coverage of original Medicare to your Medicare Advantage plan.

 

 


In the beginning they use one of those expensive ones, but eventually changed to Avastin, apparently I do better on Avastin. than with the other two.
The foundations that I am dealing with is called Gooddays. and they have been generous with me.
Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare? 
Yes, even this insurance does  cover Avastin.
You know, perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental I believe that they have stopped asking the Foundation and just bill my insurance.
I have seen the bill and there is a test that they do before they put the injections to see if there is any change in my eye. and then they put the injection. so is the injection plus the test and the doctor's visit. The insurance covers it all except for my copay for an specialist. Now, there is no progression for a very long time. as it is, I am going only about every 10 weeks and he wants to space it even more. I guess I was lucky, because I saw the eye doctor every six months because of diabetes, he was the one that saw that I could have a problem and immediately sent me to the retina specialist. I guess it was treated very early. is only in one eye and I can  see quite well under the circumstances and my other eye is not affected, and I have very good vision on that eye. I still can drive without a problem which is very important for me.

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