Okay, I've narrowed it down to two (health care) options

14 years ago

If you can stand one more post on Medicare/health care.....

I spent some time on the phone today with reps from two health insurance companies, and I'm ready to make a decision. As I mentioned in another thread, my monthly health care premiums will total $480 next year unless I make a change. Here are two options:

I could replace my Blue Cross supplement with the one offered by AARP/United Healthcare. This would cost $136/mo. (as opposed to something like $230) and provide the same coverage. I would keep my Part D Rx plan with United, so that adds another $40, more or less.

Option 2 is to sign up with Geisinger Gold, a Medicare Advantage Plan (MAP). The premium on this plan is $36/mo. Like most MAPs, it charges co-pays. There's also a $1,300 deductible. But the most I would pay out of pocket over the the year is $1,500. The policy includes prescription drugs.

Of course with either of these I'll have to continue to pay the Medicare premium, which they raised (for me) to $200. Here, then, is the math:

Sticking with Blue Cross (not an option!) would cost me $5,760 for the year (including Medicare and Part D).

Going with the AARP policy would cost me $4,512.

Choosing Geisinger Gold would cost me a maximum of $4,332--and that's assuming I pay the full $1,500 out-of-pocket amount. If I don't need that much health care, I would pay less.

I'm thinking I should get over my aversion to MAPs/HMOs and go with Geisinger. Unless I'm missing something (in which case please tell me!), it makes no sense not to.

I hope sharing this experience will help someone else sort out their own thinking on Medicare choices.

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Comments (19)

ravencajun Zone 8b TX
14 years ago
I can not help because I know zero about it and not at the age to do that yet but I do know several people that are using a plan by this company and have very good things to say. one of the ones from this company is Texan Plus which is what my friends have.

I hope you can find a happy solution I know how hard making those kinds of decisions are. My husband just will not even face the fact he needs to be investigating too.

Here is a link that might be useful: universal
dedtired
14 years ago
I cannot tell you how much this helps me! I get a stomachache just thinking about it. Is Geisinger available to anyone in PA? I am outside of Philadelphia. I am so accustomed to having a PPO, I would have a hard time adjusting to an HMO. My family doctor won't give out a referral for love nor money. I like being able to go to my dermatologist as needed.

I have to say that when I sit down and look at my overall budget, I may end up opting for the Advantage plan. Blech. It does seem to make the most financial sense and you will still get good care.
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Each and every one of those folks are going to be charged ER rates, which is probably 2-3 times more than a regular office visit, even including the time off work. Which may have something to do with Americans "paying twice as much" for care than other parts of the world, if in fact we do. If we do it is probably the ONLY thing we pay more for. I believe that I am intelligent enough to make my own decisions, and am old enough to take responsibility for my own actions or inactions. Whatever they may be. I wonder how many folks will be thrown into financial trouble by these plans (even those without a communist bent). With many living paycheck to paycheck and that's without insurance... how much worse off will those that we are supposedly trying to "help" be? How many will tank out and go under with the additional tax burden? Yes, it sounds good as long as you do not scratch the surface. So did ARM's and IO loans not too long ago......
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carol_in_california
14 years ago
We have Secure Horizons/United Healthcare through the Teamsters's Union and have had it since my DH retired in 1992.
It has worked well for us but mainly because I have worked with health care facilities having HMO's and because I have worked with many of the MD's in our HMO.
I am very assertive when it comes to our health care.
We do have co-pays......$10 for the primary care and $20 for specialists. We do have to wait for HMO authorization for specialist visits, certain diagnostic imaging and procedures.
In case of an emergency the process is expedited.
Our prescriptions are covered but with co-pays.
It is what we can afford....not ideal but it works for us.
alisande
Original Author
14 years ago
Dedtired, go to Geisinger Gold's site and click on the PPO Plans (or whatever you want). You'll be asked to put in your county, and they'll tell you what's available. Geisinger Gold has both HMO and PPO plans. Hope this helps!

Carol, United Healthcare doesn't offer an HMO in my county. This ticks me off because I wouldn't dream of using a physician in my county, mostly because of the hospital here. All my medical care takes place in a neighboring county, where UH does offer an HMO. But because I live here, it's a no-no.

Raven, thank you for the link, but I don't dare fill my already cross-eyed head with information from even one more health insurance company! LOL
jae_tn2
14 years ago
my advisoe told me to not mess around with my current plan with bc/bs because i have used it satisfactorily and with enough frequency that i don't need to make a change that will be going backward. i changed my rx to united which should cost less than my current bc/bs. i was told when i signed up last year to stay away from the advantage because of the referral necessity and the co-pays and other reasons that made sense but i have forgotten. you might check if you can go back to a supplement if you decide the advantage doesn't work for you. i almost think this was an issue.
alisande
Original Author
14 years ago
I did check that out, Jae. I asked both United and Geisinger, and they both said I could go back to a regular supplement if I wanted to.

They both also said that Medicare mandates what the plans cover; therefore, every comparable plan (and they consider the United and Blue Cross plans--Parts C or F--to be comparable) must cover the same charges, in the same amount. Given that, I don't know how Blue Cross can charge so much more for the same product. I guess they have the name recognition.
foggyj
14 years ago
Good luck on which ever you choose. I can't believe how complicated they make this process. Well, maybe it's as a previous poster said, they do this on purpose.
mare_wbpa
14 years ago
Susan, are you stuck with Geisinger providers with the Geisinger Gold? I'm not a fan of the Geisinger Health Care system, having had to deal with them last yr. I was seeing a Dr who's office was in one of their facilities, when I got a bill, I was billed $100 for the MD and $112 for use of the facility during the visit.
alisande
Original Author
14 years ago
I think I am, Mare, but I'm not seriously concerned because I had Geisinger insurance with my last full-time job and had no complaints. I can keep my current doctor. I'm still a little bit on the fence between Geisinger and AARP. The biggest thing holding me back is the thought that if I had a serious illness I might want to go out of the area for treatment. I hope that possibility is remote, but still should be considered.

What a wacky (and unpleasant) bill you received!
vala55
14 years ago
After you have decided for sure which you want, figure out how much you save per month and see if the change is worth it. I have never, ever had a problem with BCBS. I don't even pay a deductible. I never have to fill out papers or anything.
mare_wbpa
14 years ago
That's what I was wondering Susan, your ability to have access to out of area and out of Geisinger Health System care. That bill I received wasn't one isolated instance, and not an error. I received treatment at a Geisinger facility for a couple of months on a recommendation from a friend. Every time I had to see the MD in charge of the treatment I was charged as I previously described. BC/BS paid for the Rx but didn't pay for the MD visits til I met the deductibles for BS and Major Medical, 2 different deductibles, I ended up paying for most of the visits out of pocket.
A couple of yrs ago I fell and had a severe Fx of my upper arm bone. There was a possibility of needing a shoulder replacement, so I chose to go out the area for surgery in case I did need the replacement. I has BC/BS at the time, so that wasn't an issue. I like to keep my options open, you never know what can happen. It's impossible to see into the future, the best you can do is to try to prepare for the eventualities that you can think of. I always say that if strange things can happen, they will happen to me.
alisande
Original Author
14 years ago
Mare, that's something I plan to find out this weekend, or Monday. I'll report back!

Vala, if I go with AARP/United Healthcare, with coverage identical to BCBS, I'll save $1,248 for the year. If I go with Geisinger and end up paying the maximum out-of-pocket expenses in co-pays and the deductible, I'll save $1,428 over BCBS. If I go with Geisinger and the opposite happens--I require no health care during the year--I'll save almost $3,000.
monica_pa Grieves
14 years ago
Isn't Geisinger a closed network? If you take their Advantage, will you be covered on vacations? Or even in adjoining states?

I looked at them briefly a couple of years ago, and figured the closed doctor list (BTW - PA Blue Cross's new low-premium 65 Select is similar, cheap but choice of specialists is limited) was not for me.
Granlan_TX
14 years ago
Oh my Susan! I'm exhausted and feeling desperate just reading about your information and what other posters have to say. I wish us all the best...sure isn't easy or cheap!

Thanks for sharing; I do appreciate it. :)
dedtired
14 years ago
Nope, I am not eligible for Geisinger. I live in Montgomery County.

I've always heard that Geisinger is a great hospital.

I am clipping this post. It is so helpful
vala55
14 years ago
Monica, did I understand you right...some insurance doesn't cover in other states????
User
14 years ago
We have had Geisinger Gold HMO for a few years now and renewed with them again. They are the number one rated (Consumer Reports) in the state of PA and I think 7th in the nation. I read the article a few months ago. When my husband fell off our two story house last year and had a broken back, concussion , punctured lung, and was hospitalized for four days, we received nothing from Geisinger except a $15 bill for the phone in his room. Everything was covered. I sometimes have a $15 co- pay but not when it's a wellness checkup. The bad thing is I can't join my doctor's new boutique practice because they won't accept his referrals.
monica_pa Grieves
14 years ago
According to Geisinger's web site, they only have coverage in certain counties in PA. You must go to a Geisinger doctor and/or hospital for full coverage.
It does have an excellent reputation, but it is available only in certain areas in Pa...otherwise you pay the freight.

The company will write policies for PA residents in counties where they don't have coverage, but you would have to travel to another county that does for medical care.

It is very small, but again, very excellent eervices for people in a limit6ed area.

The ink below describes their coverage area.

Here is a link that might be useful: Key facts from Geisinger web site
vala55
14 years ago
Thank you Monica. I have never heard of insurance that won't cover you anywhere in the USA.

Every year we were given options to get a cheaper version of our insurance and it limited us to which doctors and hospitals we could go to and we always kept what we had. They don't do that anymore, you can go to any doctor or hospital you choose, but they still have options. My friend just chose a cheaper version last year and the rep lied to her and said there was no changes in coverage. Now she is having to pay some of her medical bills. She tried to go back to what she had previously and she can't pass the physical.

Okay, I've narrowed it down to two (health care) options

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ravencajun Zone 8b TX

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