Choosing the Right Out-of-Pocket Expenses
Q: I am seeking information regarding all out-of-pocket costs for the various Medicare health insurance plans offered to Brevard County, Florida residents. Due to my schedule, e-mail is the best way for me to correspond. Also, with the deadline quickly approaching for signing up, I need information ASAP.
A: According to our search on Medicare.gov, there are 57 Medicare Part D Prescription drug plans, 27 Medicare Advantage health plans and 12 Medicare Special Needs plans. This does not even include the infinite number of Medicare supplemental health plans available. Medicare Advantage plans replace your current Medicare, and many provide coverage toward prescription drugs. Coverage on Medicare Advantage HMO plans is usually comprehensive with low monthly premiums and co-payments. However, under a Medicare HMO plan, you will need to select a primary care physician that is part of the insurance company network. There are many companies offering Advantage plans in Brevard County, including United HealthCare, Humana, WellCare, Health Net, HealthSpring, Unicare, and many others.
A Medicare supplemental plan is a policy you purchase to complement your Medicare Part A and Part B coverage. These types of policies allow you more freedom in choosing your physicians, but the monthly premiums can be high, especially if you want coverage as comprehensive as that offered under a Medicare Advantage HMO plan.
We do not actually sell Medicare plans through our agency. We are more of a directory and consumer assistance resource. We provide you with help in finding what you are looking for and point you in the right direction. We do not charge a fee for our services. If you can be more descriptive with your request, we can provide you with a list of resources to gather this information. If you can reply to a couple of questions, we can better assist you.
Do you know specifically what type of Medicare health plan you are looking for? Advantage HMO, Supplemental, Part D Prescription Drug, etc.
Are you new to the Medicare system? Or are you looking to change plans?
If you are switching plans, what type of plan do you currently have? And what are you specifically looking for in a new plan?
I am currently enrolled in a PPO plan with Humana, whom I have grown dissatisfied with. I was told before I signed up with them that my only out-of-pocket expenses would be $30 per month for the insurance premium (plus the Medicare premium was still deducted from my Sociol Security check each month),$10 per visit to a primary care physician, $35 per visit to specialists, a $250.00 deductible for prescriptions and, after the deductible for drugs were met, I would pay 25% for each drug. The plan was also supposed to cover 100% for one visit per year to a dentist for a cleaning, X-rays, etc.(more about that in a minute), an eye exam and a YMCA membership. Problems arose (particularly with the dental) because the provider information they provided was confusing and obscured. In the introductory package they sent, both a letter and within the first few pages of the provider handbook members were instructed to go to Humana’s website for a full list of providers (which I did when I went looking for a dentist and went to one listed there). To make a long story short, after I had already been told by the dentists office that my insurance would cover my visit and I had received treatment, Humana told me that the dentist I went to see was NOT a provider and I was stuck paying nearly $150.00 just to have my teeth cleaned. And, despite being told that my out-of-pocket would be limited to the amounts I mentioned earlier, I have received additional bills from providers amounting to $100.00 or more. Therefore, I am seeking an insurance provider who does not mislead their members and pays for what they promise to pay for. I need a plan with low premiums that covers physician visits and whatever tests the physician recommends, hospitalization, some dental and vision and prescriptions. And I would like an estimate of what all out-of-pocket expenses will be so that I can compare it to what I had to pay with my current plan and to other competing companies plans. Thank you.
Comment by Ali — December 16, 2006 @ 1:37 am
There is no guarantee that there will not be miscommunication issues with any other insurance company that you choose. It is unlikely that Humana intentionally deceived you. These types of issues are most often a result of speaking with a less than knowledgeable customer service representative. There is no way that we, or anybody else, can assure that any other insurance company that you select will not have similar issues. Our agency is no longer involved in the direct sale of health insurance, but for many years we were. We dealt directly with many different insurance companies, and were always amazed at the lack of knowledge by some of the customer service representatives working for these companies. We would call several times regarding the same issue, and each time get a different answer from a different representative. The lack of knowledge of these customer service representatives are definitely a reflection on the insurance company, and are the result of many of the complaints filed against the insurance companies.
I suppose the best way to reduce this risk would be to find an insurance company with a lower complaint ratio. The Florida Department of Insurance and the U.S. Department of Health and Human Service Medicare website may be good places to start. Florida also has a Senior Health Insurance Assistance Program called SHINE that might be of some assistance.
Comment by admin — December 16, 2006 @ 9:13 am