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Re: Optum RX - STAY AWAY

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Message 31 of 129

That really  sounds great to me. I hope you never get very sick, have to stay in a hospital and/or have to go to a skilled nursing facility, get cancer or have any other catastrophic health problems. You're costs can be thousands of dollars. You seem like a very intelligent person and I don't know where you live. I live in the San Francisco Bay Area and there is not a Medicare advantage plan like that. I just hope you've done your homework. That said, I'm happy I never have to worry about paying anything except my monthly premium. No co-pays for anything, no deductibles for A or B, I pay nothing if I need 1 surgery or 12. I also don't have perfect health and almost died last year so I'm happy being covered for whatever can happen. 

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Re: Optum RX - STAY AWAY

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Message 32 of 129

I"m not sure where you live and what your Advantage plans look like, but Medicare is Medicare. All payments from Medicare are the same to doctors. Medicare pays 80% and the supplement picks up the rest. You have no costs after treatment because you pay it up front with your $150 monthly premium. That will go continue to go up as you age.

I have no monthly cost. I pay a copay for each visit to a doctor of $45 if he's a specialist. Nothing for Primary care. I can control that by who I see and how often. And I can see anyone I like. After my copay, I have no bills for most procedures. An outpatient surgery is $405 copay. But there are no other charges. You will have paid that cost in monthly premiums over three months whether you have surgery or not.

As far as doctors not taking Advantage plans, they can't tell the difference. Having to stay within a network of doctors varies by plan and those plans are usually privately backed by local healthcare systems in one area trying to monopolize business. With UHC you can go almost anywhere. They are huge.

Private doctors may limit their practice for Medicare because Medicare as a rule does not pay well (Thank the Republicans and this will get worse if Trump is reelected. They've run up a trillion dollar deificit giving tax breaks to the wealthy and they will recover that by penalizing the old and poor) A doctor. will go broke if he has to subsist on Medicare. But hospitals don't care. If they take any Medicare, they have to take ALL Medicare.

Most salesmen who sell policies sell supplements because their kickback is better from the insurance companies. They also have to retrain in Advantage plans every summer to be certified to sell them. Most don't want to do that so they sell supplement plans as if they are better when they are not. The salesmen are just lazy. They don't get paid as much and they have to put out too much. Your welfare is not their concern. My salesperson told me this. I am very happy she talked me out of a supplement and into an Advantage plan. My only problem is that the best plan out there is UHC AARP and I have to take Optum with it. So I just work around Optum. She has saved me a ton of money.

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Re: Optum RX - STAY AWAY

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Message 33 of 129

I'm sorry but that's not true. A lot of Dr's don't take Medicare Advantage. You have to stay within a particular network of doctors and I don't like that. It's worth it to me to pay extra. The benefits are also better. It's a choice I made because I saw what those plans did to people and their health. I'm not being snobby but this is from my experience working with very upset patients who have been turned away from providers they've seen for years. HMO's have more control over your healthcare and the doctors have to put up with their BS. They often have to fight with them for procedures or tests they order. Look at the issues people are having with their prescription coverage and dealing with Optum. I want more control over my healthcare. Sad but true. 
Nina

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Re: Optum RX - STAY AWAY

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Message 34 of 129

Advantage plans don't dictate any part of your healthcare to you. You can go to any physician you want to. They are the same as any supplement plan, but they often don't have any monthly coverage costs. With your supplement plan, you are paying $150 a month in addition to your Medicare deduction from your social security check. That's $1800 a year extra.

I pay nothing for the same benefits with my Advantage plan. While you may have no copays for dr. visits, I have a $45 copay for a specialist visit (nothing for primary care).And no other charges. I would have to go to a doctor three times every month to get to the costs you pay monthly. That never happens. So I save money with my advantage plan even if I have up front costs. It's so much cheaper. It's like paying ala carte for food vs. paying a lump sum for a banquet you're not going to eat half of. Insurance companies under Medicare have to offer the same product. Medicare coverage is way different than private insurance plans. You are paying extra for no extra coverage.

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Re: Optum RX - STAY AWAY

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Message 35 of 129

I should also say that UHC pays all my Medicare deductibles (I was lucky enough to get Plan F because I turned 65 in December) but I don't think that's available anymore in 2020. There is another plan that's similar. Maybe during open enrollment you can change? It's not worth it to me to have the aggravation if you can pay but I know that not everyone has that option. My Medicare D is not an expensive plan. It's under $30 a month but I don't take many meds. I get a couple of them at Costco for dirt cheap out of pocket and don't use insurance. 
Nina

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Re: Optum RX - STAY AWAY

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Message 36 of 129

OptumRX can't and won't exchange your mom's scripts with the most expensive thing out there.  They are by law ONLY allowed to fill for whatever your doctor wrote. If they err on any side at all, they will choose the cheapest generic they can find with which to fill your prescription. They will not give you choices for generic manufacturers when one might work better for you than another. They say they are too big and they can't provide that service. Some private pharmacies will do that though. You can call around and find the manufacturer you like at the pharmacy of your choice. They have to tell you which company they use to fill which medicine's generic and you can request one over another. You are not obligated to use Optum. If you are having an issue with a medication, ask your doctor to rewrite the prescription and get it in paper form. Then take that script to wherever you get the best deal. My husband's script for Indomethacin at Optum costs several hundred dollars. At Costco we got it for less than $30. Kroger has a savings club you can join for a few bucks a year. My $47 prescription at OptumRX costs me nothing at Kroger as long as I subscribe to the club. The subscription is less than the cost of one script with Optum. So you have to do your homework but you can beat the idiots at Optum.

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Re: Optum RX - STAY AWAY

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Message 37 of 129

Sorry, I don't know much about Medicare Advantage. I personally don't like any HMO coverages because I know how they operate. It's a big stretch for me to pay an extra $ $150 per month on top of the Social Security Medicare premium. It is worth it for me not having the headaches even though it's more expensive and I'm not a wealthy person by any means. I don't like insurance companies dictating to me how to handle my medical care. 

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Re: Optum RX - STAY AWAY

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Message 38 of 129

if you are on the advantage system......only

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Re: Optum RX - STAY AWAY

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Message 39 of 129

Yes. It's an AARP/UHC Advantage Plan. It costs me nothing per month.  But I'm stuck with the idiocy that is OptumRX. After three years I have learned to work around them. There are many ways to do it. Don't expect them to change and don't expect AARP to help you. I think they are doing their members a terrific disservice, but AARP doesn't seem to care as they must be getting a great kickback from UHC.

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Re: Optum RX - STAY AWAY

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Message 40 of 129

Interesting. I have United Healthcare supplement and Express Scripts. Is that with Medicare Advantage only?

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