Medicare Supplement Policies?

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galectin
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Medicare Supplement Policies?

Post by galectin » Fri May 05, 2017 6:33 pm

I have just retired (Woo-Hoo!) and am looking for a supplemental policy for Medicare parts A and B, which we have already signed up for. My wife and I have determined that we would be best served by a Part G plan. We are set for Part D. Does anybody have any experience/advice on navigating the alternatives available and have any recommendations of good or bad companies to deal with?

One issue is that I am in my second year of remission for Non-Hodgkin's Lymphoma and am getting an anti-B cell monoclonal antibody infusion every other month to help me stay in remission. Our current benefit statements say that these are about $12,000 each, but I hit my deductible in January. I have talked to a couple of company's representatives on the phone and they say that there is no problem with me signing on with them without any concerns about waiting periods, etc. for pre-existing conditions. Does that match up with other folks experience?

robertalpert
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Re: Medicare Supplement Policies?

Post by robertalpert » Fri May 05, 2017 6:53 pm

I have plan G and from my view it is the best choice. If you have a pre-existing condition, then this may be your only opportunity to ever get plan G with guaranteed issue.

I'm in Ohio and the best carrier (lowest premiums) for plan G is with Medical Mutual of Ohio. But they do not sell in other states.

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Steelersfan
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Re: Medicare Supplement Policies?

Post by Steelersfan » Fri May 05, 2017 7:29 pm

I have Plan F, which is very similar to Plan G. Plan F is scheduled to cease accepting new clients in 2020. If I had it to do all over again I would have gladly picked Plan G.

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Watty
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Re: Medicare Supplement Policies?

Post by Watty » Fri May 05, 2017 9:49 pm

I found the book "Medicare for Dummies" to very good despite it's title. Be sure you are looking at the most current edition since there have been a lot of changes.

There are trained medicare "SHIPP" counselors that may be able to help you with questions.

https://www.medicare.gov/Contacts/#resources/ships

In picking out a supplement you really need to dig through the numbers and not just look at the first $XXX per month figure you see. One of the things that I found is some providers will give a discount at first but that might be reduced by 10% a year so ten years later you could be paying a lot more than with some other providers.

When I went through this for my wife we also found that the "G" was the best choice for her. For some reason the difference in cost of the "F" plan was a lot more than the part B deductible, which is the only difference, so that was an easy choice.

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Hondo
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Re: Medicare Supplement Policies?

Post by Hondo » Sat May 06, 2017 7:46 am

After a lot of research my wife and I went with Plan G issued by our state farm bureau which is administered by Blue Cross. It was the lowest cost available for Plan G. (No, we're not farmers and never have been.)

You can get the rates for all carriers in your area at http://www.freemedicarereport.com.. It asks for an email address, but will accept any thing you enter. It's amazing the price differential for the same plan.

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dm200
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Re: Medicare Supplement Policies?

Post by dm200 » Sat May 06, 2017 9:02 am

I also recommend investigating and considering a Medicare Advantage plan (or the similar Medicare Cost). Such plans differ greatly from each other and differ greatly by locality. With such plans, you do not get a supplement.

Vanguard Fan 1367
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Re: Medicare Supplement Policies?

Post by Vanguard Fan 1367 » Sat Jul 01, 2017 9:02 am

Hondo wrote:After a lot of research my wife and I went with Plan G issued by our state farm bureau which is administered by Blue Cross. It was the lowest cost available for Plan G. (No, we're not farmers and never have been.)

You can get the rates for all carriers in your area at http://www.freemedicarereport.com.. It asks for an email address, but will accept any thing you enter. It's amazing the price differential for the same plan.
It really is the same plan? Same coverage? Same Doctors? Same response time on the telephone? Same nice people helping?

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TheGreyingDuke
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Re: Medicare Supplement Policies?

Post by TheGreyingDuke » Sat Jul 01, 2017 9:12 am

This is a frequent topic here and it is important to understand that there is no one "best" plan for everyone. When it comes to health insurance we tend to have a different perspective as compared to our ideas about other insurance (home, auto, life). In those latter instances we are delighted when we do not collect on them but when it comes to health insurance we want to calculate how much we will collect.

Buy as much insurance as you need; on my auto I have a $1000 deductible on collision, because I can afford the deductible. With Medicare supplement I have bought the f high deductible because I can afford the deductible, I am in good health (here I am calculating return :) ), and I like the ease of knowing where I stand. Once I hit the deductible then the plan covers 100%, no further co-pays and the sort. And with the High F all preventive care is provided at 100% (physical, immunizations).

As to the questions about customer service; in my experience they are not important. The clinician sends the bill t Medicare and the supplemental carrier, they each pay whatever they are going to pay, and you get a bill for the rest from the provider. I have yet to have an instance when there has been no need to call anyone about anything. There is no "network", all Medicare accepting providers are reimbursed.
"Every time I see an adult on a bicycle, I no longer despair for the future of the human race." H.G. Wells

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dm200
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Re: Medicare Supplement Policies?

Post by dm200 » Sat Jul 01, 2017 9:20 am

galectin wrote:I have just retired (Woo-Hoo!) and am looking for a supplemental policy for Medicare parts A and B, which we have already signed up for. My wife and I have determined that we would be best served by a Part G plan. We are set for Part D. Does anybody have any experience/advice on navigating the alternatives available and have any recommendations of good or bad companies to deal with?

One issue is that I am in my second year of remission for Non-Hodgkin's Lymphoma and am getting an anti-B cell monoclonal antibody infusion every other month to help me stay in remission. Our current benefit statements say that these are about $12,000 each, but I hit my deductible in January. I have talked to a couple of company's representatives on the phone and they say that there is no problem with me signing on with them without any concerns about waiting periods, etc. for pre-existing conditions. Does that match up with other folks experience?
I also suggest evaluating all Medicare Advantage (MA) and Medicare Cost (MC) plans available in your area as well. With those, you do not purchase a Supplement. The usually (as an option) include the drug coverage.

lostridge
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Re: Medicare Supplement Policies?

Post by lostridge » Sat Jul 01, 2017 9:33 am

What about someone that is 60 years old, totally disabled on SS and becoming eligible for Medicare. Where can I get a quote for Plan G? Every time I try to get a quote, I can't insert 60 for age, it will only go down to 65. Is there anyone in the same situation? Will my Plan G be higher since I am disabled or lower because I am younger? I am looking for a supplement in the state of NC. I am pretty sure I will take original medicare A and B and purchase a supplement and a Part D plan..

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Re: Medicare Supplement Policies?

Post by Spirit Rider » Sat Jul 01, 2017 9:56 am

Vanguard Fan 1367 wrote:
Hondo wrote:After a lot of research my wife and I went with Plan G issued by our state farm bureau which is administered by Blue Cross. It was the lowest cost available for Plan G. (No, we're not farmers and never have been.)

You can get the rates for all carriers in your area at http://www.freemedicarereport.com.. It asks for an email address, but will accept any thing you enter. It's amazing the price differential for the same plan.
It really is the same plan? Medicare mandated. Same coverage? Medicare mandated. Same Doctors? Doctors can accept Medicare assignment or not, but not by insurance carrier. Even if they could, the Doctors would have no reason to do so, because the remibursement rates are mandated by Medicare. Same response time on the telephone? Maybe/maybe not/maybe better. Same nice people helping? Maybe/maybe not/maybe better.
If it is a few bucks difference, then maybe it might be better if you knew for sure that one insurance carrier had better customer service than another. However, most SHIP counselors recommend the lowest cost provider once you have determined the Medicare Supplement Plan you want.

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thursdaysd
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Re: Medicare Supplement Policies?

Post by thursdaysd » Sun Jul 02, 2017 1:44 pm

I wound up choosing between BlueCross/BlueShield and AARP UnitedHealth. I went with the latter because I could not get a straight answer out of BCBS about what happened if I moved to a different state. I currently have Plan F but may see about moving once it is closed to new applicants.
Thursday's child has far to go

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CWRadio
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Re: Medicare Supplement Policies?

Post by CWRadio » Mon Jul 03, 2017 8:40 am

Also check to see how the supplement plan (Medigap) increased rates each year. Insurance companies can request a increase in rates if they are below the required loss ratio. http://www.investopedia.com/terms/l/los ... out-no-ads
https://www.cms.gov/CCIIO/Resources/Dat ... s/mlr.html. A lot of sick people on your insurance supplement plan may cause a rate increase.
Then check is the cost model of the insurance supplement policy. Three types of costing models. Community rated, Issue age rated and Attained age rated. https://www.medicare.gov/supplement-oth ... icies.html Paul

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Re: Medicare Supplement Policies?

Post by mouses » Mon Jul 03, 2017 8:48 am

I have AARP Medigap Plan F. I am short on time to go look again as I did once before. but the premiums have been reasonable for years.

I prefer Medicare + Medigap vs. Medicare Advantage because I was tired of fighting with insurance companies in my employer-provided pre-Medicare life, and Medicare Advantage gives the Medicare Advantage companies more power to make the patient's life miserable. Also they charge the feds (that's us, the taxpayers) more for the same services Medicare + Medigap provides. The last I heard it was 17% to 14% more.

Medicare + Medigap Plan F is hands off for the patient, it "just works."

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Re: Medicare Supplement Policies?

Post by neilpilot » Mon Jul 03, 2017 8:54 am

dm200 wrote:I also recommend investigating and considering a Medicare Advantage plan (or the similar Medicare Cost). Such plans differ greatly from each other and differ greatly by locality. With such plans, you do not get a supplement.
However, with a Medicare Advantage plan you often also do not get the freedom to choose the doctor or specialist you want to see.

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Re: Medicare Supplement Policies?

Post by mouses » Mon Jul 03, 2017 8:57 am

neilpilot wrote:
dm200 wrote:I also recommend investigating and considering a Medicare Advantage plan (or the similar Medicare Cost). Such plans differ greatly from each other and differ greatly by locality. With such plans, you do not get a supplement.
However, with a Medicare Advantage plan you often also do not get the freedom to choose the doctor or specialist you want to see.
I don't know if it's just a feature of my AARP Medigap plan, but I can see any doctor with no pre-approval. I always check with my internist first, but she has to do no paperwork, no nothing for this to happen. The specialists do ask who referred me and I say her.

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Re: Medicare Supplement Policies?

Post by CWRadio » Mon Jul 03, 2017 9:04 am

mouses wrote:I have AARP Medigap Plan F. I am short on time to go look again as I did once before. but the premiums have been reasonable for years.

I prefer Medicare + Medigap vs. Medicare Advantage because I was tired of fighting with insurance companies in my employer-provided pre-Medicare life, and Medicare Advantage gives the Medicare Advantage companies more power to make the patient's life miserable. Also they charge the feds (that's us, the taxpayers) more for the same services Medicare + Medigap provides. The last I heard it was 17% to 14% more.

Medicare + Medigap Plan F is hands off for the patient, it "just works."
As of 2020, Medicare Supplement plans (AKA Medigap) will no longer sell new Medigap Plan C or F. Congress has decided that new Medigap plans will no longer be allowed to cover the Part B deductible after January 1, 2020. This will only affect plans C and F.

So if no new people can join plan F, does this mean only current members and soon to be sicker members will be left on plan F. Without younger and healthier people joining plan F, who will be left on the plan? Older and sicker members. This might cause a increase for Plan F rates in the future.
Paul

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Re: Medicare Supplement Policies?

Post by neilpilot » Mon Jul 03, 2017 9:28 am

mouses wrote:
neilpilot wrote:
dm200 wrote:I also recommend investigating and considering a Medicare Advantage plan (or the similar Medicare Cost). Such plans differ greatly from each other and differ greatly by locality. With such plans, you do not get a supplement.
However, with a Medicare Advantage plan you often also do not get the freedom to choose the doctor or specialist you want to see.
I don't know if it's just a feature of my AARP Medigap plan, but I can see any doctor with no pre-approval. I always check with my internist first, but she has to do no paperwork, no nothing for this to happen. The specialists do ask who referred me and I say her.
Maybe it depends on terminology. A "Medigap" plan, such as F, G etc will allow you to choose any doctor. However, an "Advantage" plan as referenced by dm200, is NOT the same as a Medigap plan, and often operates as an HMO with limited choice of doctors. I suspect, mouses, that your plan is NOT an Advantage plan, but a Medigap plan similar to my G plan.

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dm200
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Re: Medicare Supplement Policies?

Post by dm200 » Mon Jul 03, 2017 10:02 am

neilpilot wrote:
dm200 wrote:I also recommend investigating and considering a Medicare Advantage plan (or the similar Medicare Cost). Such plans differ greatly from each other and differ greatly by locality. With such plans, you do not get a supplement.
However, with a Medicare Advantage plan you often also do not get the freedom to choose the doctor or specialist you want to see.
Yes - but it depends on the details of the plan.

In my Kaiser Medicare Cost (similar to Medicare Advantage) plan, I normally must see Kaiser providers. However, I can use Traditional Medicare and use any provider that accepts it. I have no current plans to use it.

Some Medicare Advantage plans have networks of Physicians that practice in their own offices. In those plans, you can choose a provider in the network.

Depending on the area and other details, on traditional Medicare you must find a Physician who accepts Medicare patients. In this area, a great many Primary care physicians do not accept new medicare patients, but will continue to see you if you are already a patient when you go to Medicare. So, there are limitations "to choose the doctor or specialist you want to see".

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Re: Medicare Supplement Policies?

Post by mouses » Tue Jul 04, 2017 6:57 am

neilpilot wrote:
mouses wrote:
neilpilot wrote:
dm200 wrote:I also recommend investigating and considering a Medicare Advantage plan (or the similar Medicare Cost). Such plans differ greatly from each other and differ greatly by locality. With such plans, you do not get a supplement.
However, with a Medicare Advantage plan you often also do not get the freedom to choose the doctor or specialist you want to see.
I don't know if it's just a feature of my AARP Medigap plan, but I can see any doctor with no pre-approval. I always check with my internist first, but she has to do no paperwork, no nothing for this to happen. The specialists do ask who referred me and I say her.
Maybe it depends on terminology. A "Medigap" plan, such as F, G etc will allow you to choose any doctor. However, an "Advantage" plan as referenced by dm200, is NOT the same as a Medigap plan, and often operates as an HMO with limited choice of doctors. I suspect, mouses, that your plan is NOT an Advantage plan, but a Medigap plan similar to my G plan.
Yes, that's what I said. I have Medigap, not Medicare Advantage.

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Re: Medicare Supplement Policies?

Post by mouses » Tue Jul 04, 2017 7:01 am

dm200 wrote:
Depending on the area and other details, on traditional Medicare you must find a Physician who accepts Medicare patients. In this area, a great many Primary care physicians do not accept new medicare patients, but will continue to see you if you are already a patient when you go to Medicare. So, there are limitations "to choose the doctor or specialist you want to see".
I hear this at various times, but it does not seem to be generally true in my geographical area. Being on Medicare for years, I think maybe once or twice some specialist has not accepted Medicare patients.

Plus, the major teaching hospital practices seem to always accept Medicare patients; If you can get the best doctors, who cares what lesser lights do. Of course, this does not help people in isolated areas away from such hospitals.

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Re: Medicare Supplement Policies?

Post by gasdoc » Tue Jul 04, 2017 7:25 am

mouses wrote:
dm200 wrote:
Depending on the area and other details, on traditional Medicare you must find a Physician who accepts Medicare patients. In this area, a great many Primary care physicians do not accept new medicare patients, but will continue to see you if you are already a patient when you go to Medicare. So, there are limitations "to choose the doctor or specialist you want to see".
I hear this at various times, but it does not seem to be generally true in my geographical area. Being on Medicare for years, I think maybe once or twice some specialist has not accepted Medicare patients.

Plus, the major teaching hospital practices seem to always accept Medicare patients; If you can get the best doctors, who cares what lesser lights do. Of course, this does not help people in isolated areas away from such hospitals.
Are you considering getting medical care from residents to be getting care from "the best doctors?" In our area, the "best doctors" in primary care do not take new medicare patients as a rule. Most docs do not have animosity against medicare, but you should know that medicare reimbursement does not cover the cost of providing the care. Most docs (me included) provide this coverage as a service to the community and because docs are for the most part altruistic. I am not primary care, but a primary care doc cannot afford to have an entire practice of medicare patients. The "best docs" in primary care tend to be those that are 5-15 years from retirement, and their practices are full and aging (from patients they have had for a long time). They often have to limit new patients to younger, better insured patients. Just thought you should know. And in a true teaching hospitals, it is the residents, the least experienced doctors, that are providing your care. These institutions are getting cheap labor from the residents.

gasdoc

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dm200
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Re: Medicare Supplement Policies?

Post by dm200 » Tue Jul 04, 2017 8:04 am

Are you considering getting medical care from residents to be getting care from "the best doctors?" In our area, the "best doctors" in primary care do not take new medicare patients as a rule. Most docs do not have animosity against medicare, but you should know that medicare reimbursement does not cover the cost of providing the care. Most docs (me included) provide this coverage as a service to the community and because docs are for the most part altruistic. I am not primary care, but a primary care doc cannot afford to have an entire practice of medicare patients. The "best docs" in primary care tend to be those that are 5-15 years from retirement, and their practices are full and aging (from patients they have had for a long time). They often have to limit new patients to younger, better insured patients. Just thought you should know. And in a true teaching hospitals, it is the residents, the least experienced doctors, that are providing your care. These institutions are getting cheap labor from the residents.
Thanks for the professional insight.

In this area (Washington DC and Baltimore MD) Kaiser actively promotes/advertises its Medicare plan - so I have to assume that Medicare customers/patients must bring, on balance, a positive to the financial "bottom line" for them. From my experience (7 years) with the Kaiser medicare plan, I cannot see sub-par care either. Compared with folks on traditional medicare, I see Physicians (primary care and specialists) much more quickly than they do. For Primary care, I always see the Physician - and not a Nurse, Nurse Practioner or Physicians assistant.

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Re: Medicare Supplement Policies?

Post by thursdaysd » Tue Jul 04, 2017 10:03 am

I object to Medicare Advantage on philosophical grounds, as having grown up in England I am a big proponent of single payer. However, I have not found being on Medicare makes it difficult to find doctors in my area. I am currently looking for a new PCP and all the doctors I have considered take Medicare and all but one are taking new patients. I recently saw a rheumatologist with excellent credentials and have been referred to an infectious diseases specialist ditto, and both take Medicare. Both are associated with (different) big university medical centers, and I believe that all their practitioners take Medicare.
Thursday's child has far to go

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Re: Medicare Supplement Policies?

Post by newstreetnj » Tue Jul 04, 2017 7:09 pm

neilpilot wrote:
dm200 wrote:I also recommend investigating and considering a Medicare Advantage plan (or the similar Medicare Cost). Such plans differ greatly from each other and differ greatly by locality. With such plans, you do not get a supplement.
However, with a Medicare Advantage plan you often also do not get the freedom to choose the doctor or specialist you want to see.
Totally agree; No choice with Medicare Advantage, a real disadvantage. Have AARP and did get an initial discount but they are slowly reducing that.

Bob

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Re: Medicare Supplement Policies?

Post by Mel Lindauer » Tue Jul 04, 2017 10:43 pm

thursdaysd wrote:I object to Medicare Advantage on philosophical grounds, as having grown up in England I am a big proponent of single payer. However, I have not found being on Medicare makes it difficult to find doctors in my area. I am currently looking for a new PCP and all the doctors I have considered take Medicare and all but one are taking new patients. I recently saw a rheumatologist with excellent credentials and have been referred to an infectious diseases specialist ditto, and both take Medicare. Both are associated with (different) big university medical centers, and I believe that all their practitioners take Medicare.
Folks on Medicare need to be careful when asking if a Dr. takes Medicare (most do). Rather than ask if they take Medicare, you have to ask if the take Medicare Assignment. Huge difference.

In the first instance (they accept Medicare), they'll bill Medicare and then can bill you for additional payment over and above what Medicare pays.

In the second instance (Medicare Assignment), they agree to accept what Medicare pays as full payment for their services.

Patient beware and use the correct terminology when looking for a new Doctor.
Best Regards - Mel | | Semper Fi

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Re: Medicare Supplement Policies?

Post by bertilak » Wed Jul 05, 2017 6:14 am

Mel Lindauer wrote:Folks on Medicare need to be careful when asking if a Dr. takes Medicare (most do). Rather than ask if they take Medicare, you have to ask if the take Medicare Assignment. Huge difference.

In the first instance (they accept Medicare), they'll bill Medicare and then can bill you for additional payment over and above what Medicare pays.

In the second instance (Medicare Assignment), they agree to accept what Medicare pays as full payment for their services.

Patient beware and use the correct terminology when looking for a new Doctor.
Is the difference between "accepting Medicare" and "accepting Medicare assignment" what is called "Excess Charges?"

If so, Medicare puts a limit on how much that can be and requires the facility to display a notice saying they have "Excess Charges." That was in the fine print when I evaluated my choice between Plan F and Plan N. I have never seen such a notice and the billing offices I asked were not familiar with the term "Excess Charges" although they all said they "accept Medicare assignment," not just "accept Medicare."

I chose plan N to save a few hundred dollars in premiums per year because it looked like excess charges were not at all common and none of my doctors had them. I sill question that decision because the peace of mind might be worth the extra few hundred AND the $20 office visit charges added up faster than I thought they would so I am that much closer to breaking even. I misjudged how many visits there would be!
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Re: Medicare Supplement Policies?

Post by thursdaysd » Wed Jul 05, 2017 9:03 am

Folks on Medicare need to be careful when asking if a Dr. takes Medicare (most do). Rather than ask if they take Medicare, you have to ask if the take Medicare Assignment. Huge difference.
My current PCP does not take Medicare assignment. However, since I have Medigap Plan F this is really irrelevant to me. I do make a small payment when I see her, but then I receive a check that covers it. I agree that if you have a less comprehensve plan this could be a consideration, however, the other four providers I have seen (so far...) this year (PCP, PT, orthopedist, rheumatologist) have all taken assignment.
Thursday's child has far to go

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Re: Medicare Supplement Policies?

Post by dm200 » Wed Jul 05, 2017 9:24 am

Totally agree; No choice with Medicare Advantage, a real disadvantage. Have AARP and did get an initial discount but they are slowly reducing that.
Bob
Not always true. For some (perhaps many) MA plans (such as Humana in this area) you can choose among Physicians who participate in the plan in their own facilities.

With the HMO model, such as Kaiser Medicare plans, you often have the choice of many different Physicians. In my Kaiser plan, for example, with a few mouse clicks I can, for any reason, change my Primary Care Physician (either Internal Medicine or Family Practice) to any one of several dozen other Primary care physicians.

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Re: Medicare Supplement Policies?

Post by bertilak » Wed Jul 05, 2017 9:50 am

dm200 wrote:For some (perhaps many) MA plans (such as Humana in this area) you can choose among Physicians who participate in the plan in their own facilities.
That's the point -- you are restricted to participating doctors. That is a much smaller selection than doctors who accept Medicare assignment. You may or may not (for example) be able to use the cardiologist you want.
Listen very carefully. I shall say this only once. (There! I've said it.)

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Re: Medicare Supplement Policies?

Post by neilpilot » Wed Jul 05, 2017 9:52 am

bertilak wrote:
dm200 wrote:For some (perhaps many) MA plans (such as Humana in this area) you can choose among Physicians who participate in the plan in their own facilities.
That's the point -- you are restricted to participating doctors. That is a much smaller selection than doctors who accept Medicare assignment. You may or may not (for example) be able to use the cardiologist you want.
Also, you may or may not be able to stay with the doctor that your used for the decade before medicare

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Re: Medicare Supplement Policies?

Post by dm200 » Wed Jul 05, 2017 9:59 am

neilpilot wrote:
bertilak wrote:
dm200 wrote:For some (perhaps many) MA plans (such as Humana in this area) you can choose among Physicians who participate in the plan in their own facilities.
That's the point -- you are restricted to participating doctors. That is a much smaller selection than doctors who accept Medicare assignment. You may or may not (for example) be able to use the cardiologist you want.
Also, you may or may not be able to stay with the doctor that your used for the decade before medicare
Sure. In my opinion and experience though, it is my belief that staying with the same doctor is vastly overrated (from a health point of view).

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Re: Medicare Supplement Policies?

Post by jmw » Wed Jul 05, 2017 10:27 am

What's the advantage of taking Kaiser or one of the other inferior Medicare Advantage plans? Sorry, but they are a horrible choice unless you get sick with common illnesses that are easy to diagnose and treat. Some common illnesses are expensive, and Kaiser will cover those fine. You save a few bucks a month is the only advantage, but that advantage goes away once you start accumulating copays. The lack of choice will matter when your Kaiser primary and Kaiser specialist fails to fix your problem and you can't go out-of-network to pick out a better brain. As a long-time Kaiser patient, they will fail you in spectacular ways when your illnesses don't fit their box and you can't leave to go to the world leading specialist in xyz who is allowed to go outside of the box.

Another advantage with plan F is that you don't need to worry about copays and all the associated headaches anymore. For seniors that are having trouble managing their finances, plan F gets rid of a lot of bookkeeping headaches like SNF bills, ambulance bills, and getting credited for Medicaid if you need Medicaid spenddown (this doesn't happen automatically unless you have full Medicaid paying for Kaiser). In the Kaiser Medicare plans here, you will be rationing your care for emergencies because of the ambulance copay and the ER copay. With F, just call the cute firemen when needed without any further thought.

Unless you are broke and really think your body won't find novel ways to fail you from age 65 to 95, stay away from Medicare Advantage. Pay the $100-$200 extra every month if you can afford the only top tier platinum plated single payer insurance available in the US with traditional+ F/G supplement.

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dm200
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Re: Medicare Supplement Policies?

Post by dm200 » Wed Jul 05, 2017 10:36 am

jmw wrote:What's the advantage of taking Kaiser or one of the other inferior Medicare Advantage plans? Sorry, but they are a horrible choice unless you get sick with common illnesses that are easy to diagnose and treat. Some common illnesses are expensive, and Kaiser will cover those fine. You save a few bucks a month is the only advantage, but that advantage goes away once you start accumulating copays. The lack of choice will matter when your Kaiser primary and Kaiser specialist fails to fix your problem and you can't go out-of-network to pick out a better brain. As a long-time Kaiser patient, they will fail you in spectacular ways when your illnesses don't fit their box and you can't leave to go to the world leading specialist in xyz who is allowed to go outside of the box.
Another advantage with plan F is that you don't need to worry about copays and all the associated headaches anymore. For seniors that are having trouble managing their finances, plan F gets rid of a lot of bookkeeping headaches like SNF bills, ambulance bills, and getting credited for Medicaid if you need Medicaid spenddown (this doesn't happen automatically unless you have full Medicaid paying for Kaiser).
Unless you are broke and really think your body won't find novel ways to fail you from age 65 to 95, stay away from Medicare Advantage. Pay the $100-$200 extra every month if you can afford the only top tier platinum plated single payer insurance available in the US with traditional+ F/G supplement.
In my opinion and experience, you are very seriously ill informed OR something worse. Your scenario does not, in any way, match either my or my wife's Kaiser experience. On the contrary, our experiences have been that we each have been seen/treated much more quickly than would have been the case with Traditional medicare.

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Re: Medicare Supplement Policies?

Post by kmurp » Wed Jul 05, 2017 12:25 pm

Aren't Medicare advantage policies much cheaper than medigap?

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Re: Medicare Supplement Policies?

Post by neilpilot » Wed Jul 05, 2017 12:29 pm

kmurp wrote:Aren't Medicare advantage policies much cheaper than medigap?
There's that old adage, you get what you paid for.

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Re: Medicare Supplement Policies?

Post by GarrettBall » Wed Jul 05, 2017 2:00 pm

There's a good bit of misinformation in previous posts on this thread but hopefully folks don't make a decision based on what they read on a message board thread :shock:
Last edited by GarrettBall on Thu Jul 06, 2017 8:59 am, edited 1 time in total.

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dm200
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Re: Medicare Supplement Policies?

Post by dm200 » Wed Jul 05, 2017 2:23 pm

kmurp wrote:Aren't Medicare advantage policies much cheaper than medigap?
It all depends on the plan. Some MA plans have multiple choices. The MA (and similar MC) plans in my area are low in cost. You do not (and, in facts, cannot) purchase a supplement. There are, however, costs involved - such as copays for office visits, some diagnostic tests, surgery and hospitalization - up to a yearly put of pocket limit. Mine, for example, is $5,500 this year. Drug coverage is often included, usually as an option. My MC plan costs $25 per month in addition to the medicare part B charges.

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Re: Medicare Supplement Policies?

Post by gasdoc » Wed Jul 05, 2017 4:55 pm

From my "MBA for Physician Executives degree," I recall that Kaiser was among the least expensive because it was the "best" at managing care. What does managing care mean? There are two ways to manage care. The most difficult way is to 1) only admit patients that are healthy and are expected to remain healthy, 2) provide such good care that no one ever gets sick, and 3) if they do, make sure they get well quickly. The easiest way to manage care is to simply deny care that is expensive to provide. Simply incentivize the physicians to not order expensive tests (MRI, etc.) and don't offer expensive care pathways (Don't offer that expensive cancer drug that may only provide an extra year of life, on average). Which one does Kaiser do? Would a non-physician really know when the best, but most expensive, option is not being offered? That is for the buyer to decide!!!

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FrugalInvestor
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Re: Medicare Supplement Policies?

Post by FrugalInvestor » Wed Jul 05, 2017 5:23 pm

Mel Lindauer wrote:
thursdaysd wrote:I object to Medicare Advantage on philosophical grounds, as having grown up in England I am a big proponent of single payer. However, I have not found being on Medicare makes it difficult to find doctors in my area. I am currently looking for a new PCP and all the doctors I have considered take Medicare and all but one are taking new patients. I recently saw a rheumatologist with excellent credentials and have been referred to an infectious diseases specialist ditto, and both take Medicare. Both are associated with (different) big university medical centers, and I believe that all their practitioners take Medicare.
Folks on Medicare need to be careful when asking if a Dr. takes Medicare (most do). Rather than ask if they take Medicare, you have to ask if the take Medicare Assignment. Huge difference.

In the first instance (they accept Medicare), they'll bill Medicare and then can bill you for additional payment over and above what Medicare pays.

In the second instance (Medicare Assignment), they agree to accept what Medicare pays as full payment for their services.

Patient beware and use the correct terminology when looking for a new Doctor.
Very true.

It's also important to know that some Medigap (Medicare supplement) plans will pay "excess charges" that doctors who accept Medicare but not Medicare assignment can charge. As far as I know these charges are always an additional 15%. I know that Plans F and G cover these "excess charges" which is one reason I recently chose Plan G. My guess is that as Congress attempts to control Medicare costs by reducing doctor re-imbursements that more doctors who accept Medicare will not accept assignment. There may be other plans that cover 'excess charges' as well.
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Re: Medicare Supplement Policies?

Post by jebmke » Wed Jul 05, 2017 5:47 pm

FrugalInvestor wrote:more doctors who accept Medicare will not accept assignment
Based on some anecdotal information from friends and relatives, this seems to be accelerating in some markets. In fact, quite a few not taking any medicare at all.
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Re: Medicare Supplement Policies?

Post by Alan S. » Wed Jul 05, 2017 6:16 pm

Medigap premiums are much higher than MA premiums.

Some of the difference is due to better coverage in Medigap and some of it is due to adverse selection.
I would love to know the breakdown between those two prime reasons for the higher premiums, even if only a ballpark estimate.

I would not mind paying for better coverage, but not so much for adverse selection charges. Adverse selection charges more objectionable when you are not in the adverse selection group, yet are paying to be included there.

This is typical of any insurance, eg flood insurance where purchases are concentrated with those in a flood zone. Medical is not so clear cut, but most people have a pretty good idea when they will need Medigap. For many people it is simply age driven.

If there was an option to start with MA and automatically transfer to Medigap at 75, that would probably be attractive for many.

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Re: Medicare Supplement Policies?

Post by dm200 » Thu Jul 06, 2017 8:22 am

gasdoc wrote:From my "MBA for Physician Executives degree," I recall that Kaiser was among the least expensive because it was the "best" at managing care. What does managing care mean? There are two ways to manage care. The most difficult way is to 1) only admit patients that are healthy and are expected to remain healthy, 2) provide such good care that no one ever gets sick, and 3) if they do, make sure they get well quickly. The easiest way to manage care is to simply deny care that is expensive to provide. Simply incentivize the physicians to not order expensive tests (MRI, etc.) and don't offer expensive care pathways (Don't offer that expensive cancer drug that may only provide an extra year of life, on average). Which one does Kaiser do? Would a non-physician really know when the best, but most expensive, option is not being offered? That is for the buyer to decide!!!
gasdoc
As far as I know, have experienced or have heard from credible sources, Kaiser does not, today at least, not admit those who are sickest. In all our years at Kaiser (between 1/2 and 2/3 of the last 40 years), my wife and I (and sone when he was at home) have not perceived Kaiser taking shortcuts on care. In fact, in the last year, I pushed back at getting a CT angiogram because I believed it was unnecessary. I finally saw a different cardiologist wh agreed with me. For Kaiser Medicare, there is no medical underwriting (except those with end stage renal disease, a standard for MA plans). They don't skimp by having fewer Physicians (MD and DO) either. On the contrary, they hired more Physicians and do not use Nurse Practioners, Nurses, Physicians Assistants in Primary care.

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Re: Medicare Supplement Policies?

Post by brajalle » Sat Jul 08, 2017 11:54 pm

lostridge wrote:What about someone that is 60 years old, totally disabled on SS and becoming eligible for Medicare. Where can I get a quote for Plan G? Every time I try to get a quote, I can't insert 60 for age, it will only go down to 65. Is there anyone in the same situation? Will my Plan G be higher since I am disabled or lower because I am younger? I am looking for a supplement in the state of NC. I am pretty sure I will take original medicare A and B and purchase a supplement and a Part D plan..
I didn't see this specifically addressed in glancing over. My wife is disabled and I've researched this at length. Basically, I haven't found an insurance company that will sell a Medigap plan for anyone under 65 - contact your state's SHPP to verify, but im 100% sure that's the problem. You'll be able to get a Medigap plan at age 65.

I don't know your income situation or spousal situation, but I've found that you really should do some calculations here as to what is best. Example - if I was not working, or my spouse was single, but with income in limits, the best plan options would be no Medicare Advantage (supplemental & Part D), just A & B + medicaid. Wither no spousal coverage from me, but income being out of range of medicaid, we'd have to buy a supplemental+D plan. With me working, the best option is my insurance + A&B, with Part D coverage determined specifically by monthly premium cost & how our plan handles prescription drug costs (ie high prescription costs, with a high deductible covering them + lowish other expenses + Part D drug benefits friendly to her prescriptions = take Part D & pay monthly for a $1-2k/yr drug discount), in our case, the way it works out, the best option with my work coverage is A&B only and supplemental/D are cost boosters. So YMMV & do the math.

Lastly, for anyone looking at this insurance - by all means do some heavy research. If you're looking at price alone, you're in for a world of hurt IMO down the line. I have relatives who fall into this category. The recommended Medicare for Dummies is probably a good recommendation (ie Insurance for Dummies I'd recommend for home/car/etc insurance needs - they're really pretty good in my experience). Basically though, Medicare Advantage or Supplemental plans = old private insurance problems. You're limited to certain doctors, certain geographical areas, coverage varies, etc.

As others have mentioned, sometimes the price starts out great but then discounts decrease and sticker shock sets in (AARP is one I hear mentioned on this - including from my older relatives). Medigap plans probably have a higher up-front cost on average, but don't have any of the same geographical restrictions and are always identical (a plan F is the same everywhere in coverage). As others have stated, a few plans are being discontinued. My understanding is, the risk in a plan being discontinued, is that it's risk pool can change (no new, younger, healthier people), so premium increases may be a bit faster than if they'd stayed open. The high-deductible options really didn't seem that bad to me, and are probably more likely to stay open long-term.

Lastly, and this is probably a key part that most people don't miss, is that there are 3 ways of underwriting/pricing Medigap policies. The first is by current age - it will steadily go up as you get older. Ie, the premium is calculated based on your age, and age 65 you is going to be cheaper than age 85 you. The next way is by age buckets - I believe typically every 5 or 10 years. Ie, you may be in the age 65-69 bucket with the same price, but turning 70 you may go into the age 70-74 bucket. The last way is based on age of issue - your price is always going to be the same - obviously get it issued at age 65! As you might guess, the initial premiums of the age of issue plans (or bucket, to a lesser degree) are going to be higher, but they won't increase.

It's also worth noting that at age 65 when you first sign-up, the policies are not unwritten and are must-issue (if you're on medicare prior to this by being disabled, this still applies to your age 65 window). If you ever switch plans, they will potentially underwite it and it will not be a must-issue. Ie they can decline you. The problem I see with my older relatives is they bought the lowest monthly premium AARP Medicare Supplemental plan - the prices have gone up as the premium discounts faded & as they aged, they are limited to certain doctors/hospitals, and when they travel (to a winter home for example) they have no in-network options. My mother did her research, and while she paid more to start with, I think she's sitting pretty with a nice Medigap Plan and can use it anywhere in the country. This meant that when something medical popped up that she wanted to see the best doctors for, she had the option to go out of state to someplace like Mayo/John Hopkins/Cleveland.

Do your research! Make sure you understand this really well. Alot of it depends on your personal situation, plans, and budget, but it can be a pretty darn impactful decision!

Edit - Caught up a few posts I'd skipped after the first page. Re; Adverse Selection in Medigap - I'm not so sure to be honest. Maybe? I know when looking at my mother's options a few years ago that the price was higher per month, but that the plan benefits seemed to be worth it. Re: You get what you pay for - my understanding is that Advantage/Supplemental plans get a bucket of money for each person. This is how some plans are "free" or very low cost - they build the premium, what you pay in Part D, limits, out of pockets, deductibles, etc - around their calculations of their break even on the money they get for each person. This is why plans vary so much and look alot like we're used to seeing private or employer insurance look. Medigap plans don't have arcane formulas or such, each one is the same, and, to me, this often appears to be a better option for reducing financial risk. But yea, basically, you do tend to get what you pay for, but I think my conclusion was that I'd much rather have a plan that is 100% up-front and clear vs. a plan that resembles the private/employer insurance we all have learned to hate for the loopholes, gotchas, and spreadsheet tracking.

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Re: Medicare Supplement Policies?

Post by Spirit Rider » Sun Jul 09, 2017 12:25 am

lostridge wrote:What about someone that is 60 years old, totally disabled on SS and becoming eligible for Medicare. Where can I get a quote for Plan G? Every time I try to get a quote, I can't insert 60 for age, it will only go down to 65. Is there anyone in the same situation? Will my Plan G be higher since I am disabled or lower because I am younger? I am looking for a supplement in the state of NC. I am pretty sure I will take original medicare A and B and purchase a supplement and a Part D plan..
Medicare is a challenge for people on SS disability. First, they are not eligible until after two years of disability. Typically you can not enroll online, you must contact them by phone and you will definitely have sticker shock.

All of the carriers in my state offer Medigap policies to those < 65, which means those on disability. All policies in this state are issue age rated. All of the carriers charge those < age 65, premiums >= age 91 premiums. These premiums range from 120% -> 300% of age 65 premiums and are the highest premiums charged by each carrier.

For example, Anthem Plan F charges females ~$175/month for issue age 65 premiums and ~500/month for < age 65 issue age premiums. While Continental Plan F charges females the same ~$175/month for issue age 65 premiums, but only ~240/month for < age 65 issue age premiums. So it definitely pays to shop around.

The only good news is that you still get an additional open enrollment at age 65 and enroll and get the issue age 65 premium like everyone else without medical underwriting.

I'm not sure if this is mandated by Medicare and/or my state insurance department.

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Re: Medicare Supplement Policies?

Post by orlandoman » Sun Jul 09, 2017 5:47 am

There are a number of negative comments about Medicare Advantage plans in this thread. Those comments are misplaced, the comments do not differenciate between HMO & PPO plans. Yes, most MA plans are HMO plans and there is a restriction to use network physicians and the negative comments are usually directed at those plans.

In my market, Florida, I have a PPO MA plan with United Healthcare with $0.00 monthly premiums. I can see any physician that accepts medicare, like medigap plans but I have a co-pay and higher out of pocket maximums. I pay $15 to see my personal physician & $50 in-network for a specialist & $70 out of network. Also, the most common generic drugs have a $0.00 cost also, through their mail order supplier.

So, like many things in life each situation is local to the plan options in your area & I do understand that most areas do not have the options I have in Florida.
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dm200
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Re: Medicare Supplement Policies?

Post by dm200 » Sun Jul 09, 2017 8:40 am

orlandoman wrote:There are a number of negative comments about Medicare Advantage plans in this thread. Those comments are misplaced, the comments do not differenciate between HMO & PPO plans. Yes, most MA plans are HMO plans and there is a restriction to use network physicians and the negative comments are usually directed at those plans.
In my market, Florida, I have a PPO MA plan with United Healthcare with $0.00 monthly premiums. I can see any physician that accepts medicare, like medigap plans but I have a co-pay and higher out of pocket maximums. I pay $15 to see my personal physician & $50 in-network for a specialist & $70 out of network. Also, the most common generic drugs have a $0.00 cost also, through their mail order supplier.
So, like many things in life each situation is local to the plan options in your area & I do understand that most areas do not have the options I have in Florida.
As with non-Medicare plans, there are two types of HMOs. There are pros and cons of each type. One type, like Kaiser in most areas where Kaiser offers plans, has mostly its own facilities and Physicians/providers are employees (or have dedicated contracts) of Kaiser. You usually must see a Physician/provider from that HMO. The other type of HMO is similar to a PPO in that you see Physicians/providers in that HMO network in their own offices/facilities.

Here in the Washington DC area, I am in the Kaiser plan and am very happy - both from a financial point of view and from a Medical/health point of view. Another Medicare plan that I have very satisfied friends enrolled in is the Humana plan, which is an HMO where you see Physicians/providers in their offices/facilities.

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Re: Medicare Supplement Policies?

Post by midareff » Sun Jul 09, 2017 8:48 am

Plan F in South Florida. No deductibles or co-pays or issues with existing conditions. Any doctor that takes medicare accepts it too.

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Re: Medicare Supplement Policies?

Post by Prudence » Sun Jul 09, 2017 9:12 am

Steelersfan wrote:I have Plan F, which is very similar to Plan G. Plan F is scheduled to cease accepting new clients in 2020. If I had it to do all over again I would have gladly picked Plan G.
Some have said that when Plan F ceases to accept new clients, the existing clients will have an option to switch into other plans. What are the latest predictions on this? Are the predictions based on history where another plan has been closed to new enrollees. Assuming no lapses in coverage, will we have an option to switch plans without underwriting and without punitive premium increases, relative to the premiums of peers that are enrolled in those plans. Any other consequences? I live in Maryland BTW.

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Re: Medicare Supplement Policies?

Post by Sheepdog » Sun Jul 09, 2017 9:30 am

I have used an Anthem BC/BS Medicare Advantage PPO plan now for 4 years. It includes a dental, hearing and vision package. I previously used standard Medicare with a G Medigap plus a Part D prescription plan. It has saved me over $2000 a year, not including the dental and hearing plan which I am just starting to take advantage of this spring. I can see any physician I wish. Non preferred physicians cost more...that is all. We switched from Medigap providers because the premiums were increasing exponentially every year as we aged. My wife's Humana Medicare Advantage PPO plan, now in her 2nd year, is giving us a similar $2000 a year savings as well.

I have been very pleased with the Advantage PPO plans...cost and service. $4000 a year savings and good care from the good physicians.
Last edited by Sheepdog on Sun Jul 09, 2017 11:47 am, edited 1 time in total.
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