Medicare choices

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Julyguy754
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Medicare choices

Post by Julyguy754 » Tue Feb 26, 2019 1:48 pm

I know it is a personal decision, but I was just wondering if the community had any thoughts on the choice of regular Medicare vs Medicare Advanta
They both have their positive and negative aspects. I'm having a hard time deciding between the two.
I am 64, single, no spouse, have no medical issues at this time, and am not on any medication. I like the lower cost of the advantage , but not the fact my doctor can drop them or the plan drop my doctor, as well as less flexibility and peace of mind knowing what I will pay with the regular Medicare.I would appreciate anyone's thoughts on this.
Thankyou, Julyguy

Shallowpockets
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Re: Medicare choices

Post by Shallowpockets » Tue Feb 26, 2019 2:08 pm

The big issue for most people is if they can keep their doctor or not. That is, if you had a doc you really liked before medicare.
Other reasons.
I don't want any constraints on who I go to see. Such as in an HMO, PPO.
I want to be covered everywhere (in the world too)
I don't want to have to have a referral to see a specialist.

These reasons are all personal.

A good proportion of people look down on Advantage Plans in the same way that people who have "my guy" who manages their money and you are a BH. Also they pay up for that in the same fashion.

All medicare recipients pay the base $135 a month. What else you pay depends on what plan, either Advantage or supplemental you decide upon. All the way through to Plan F.

And once again, let me say, go and buy the book medicare for dummies.

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GerryL
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Re: Medicare choices

Post by GerryL » Tue Feb 26, 2019 2:23 pm

It's good that you are thinking about this choice now, before you actually sign up. Here was my thinking:
You can easily switch from traditional Medicare to Medicare Advantage at a future open enrollment. Switching from MA to traditional is more problematic because you may not be able to get a Medicare Supplement plan later in the game.
I opted for traditional Medicare and an F high deductible supplement. (And, of course, a Part D plan.) No regrets and no thought at this time of switching to MA.

And I will second the recommendation of the Medicare for Dummies book. Make sure to look for the latest edition.

radiowave
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Re: Medicare choices

Post by radiowave » Tue Feb 26, 2019 2:31 pm

I'm still over year away from Medicare, however in my searching and looking at my HR documents at current workplace, It looks like the MA plan for me does not cover foreign travel, whereas my supplemental plan (medigap) plan does. Just an FYI if that is an issue. We're at Kaiser now and very happy overall with them. I'm not sure if Kaiser takes our medigap policy although looking online for a doctor brings up the Kaiser physicians so one more piece of the puzzle, can you get a medigap plan for traditional Medicare but use it at an HMO/PPO that also offers a Medicare Advantage plan?
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ResearchMed
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Re: Medicare choices

Post by ResearchMed » Tue Feb 26, 2019 2:32 pm

One thing to consider, in terms of whether "plain vanilla Medicare" is sufficient:
It typically does NOT include medical care outside the USA, so if you are doing - or plan to do - international travel, you'll want some sort of supplemental plan OR be sure to get travel insurance each time you leave the country (and make sure it covers any pre-existing conditions, if any; this is easy to do if one purchases the coverage within a few days of the very first payment/deposit/etc., in which case for most policies there are no exclusions for pre-existing conditions).

RM
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midareff
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Re: Medicare choices

Post by midareff » Tue Feb 26, 2019 2:50 pm

ResearchMed wrote:
Tue Feb 26, 2019 2:32 pm
One thing to consider, in terms of whether "plain vanilla Medicare" is sufficient:
It typically does NOT include medical care outside the USA, so if you are doing - or plan to do - international travel, you'll want some sort of supplemental plan OR be sure to get travel insurance each time you leave the country (and make sure it covers any pre-existing conditions, if any; this is easy to do if one purchases the coverage within a few days of the very first payment/deposit/etc., in which case for most policies there are no exclusions for pre-existing conditions).

RM
As an add on to ResearchMed's post..... Unfortunately, I had an issue overseas that resulted in emergency transport to and two nights in a private hospital in the Ukraine, with the services of both a cardiologist and an ENT. With transport and the first day I had the full time services of a translator and we (wife and I) were provided a two bed private room so she could stay with me. Besides having Medicare my AARP United Plan F picked up 80% of the charges after a $250 deductible was applied. My remaining out of pocket was about $540. .. which would have been the approximate charge for travel insurance for 1 of us.

cashmoney
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Re: Medicare choices

Post by cashmoney » Tue Feb 26, 2019 2:57 pm

midareff wrote:
Tue Feb 26, 2019 2:50 pm
ResearchMed wrote:
Tue Feb 26, 2019 2:32 pm
One thing to consider, in terms of whether "plain vanilla Medicare" is sufficient:
It typically does NOT include medical care outside the USA, so if you are doing - or plan to do - international travel, you'll want some sort of supplemental plan OR be sure to get travel insurance each time you leave the country (and make sure it covers any pre-existing conditions, if any; this is easy to do if one purchases the coverage within a few days of the very first payment/deposit/etc., in which case for most policies there are no exclusions for pre-existing conditions).

RM
As an add on to ResearchMed's post..... Unfortunately, I had an issue overseas that resulted in emergency transport to and two nights in a private hospital in the Ukraine, with the services of both a cardiologist and an ENT. With transport and the first day I had the full time services of a translator and we (wife and I) were provided a two bed private room so she could stay with me. Besides having Medicare my AARP United Plan F picked up 80% of the charges after a $250 deductible was applied. My remaining out of pocket was about $540. .. which would have been the approximate charge for travel insurance for 1 of us.

Just know that the foreign travel benefit on medicare supplement has a 50k lifetime benefit whereas most Medicare Advantage plans have a 90.00 copay for foreign travel emergency with no lifetime limit.

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ResearchMed
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Re: Medicare choices

Post by ResearchMed » Tue Feb 26, 2019 3:01 pm

cashmoney wrote:
Tue Feb 26, 2019 2:57 pm
midareff wrote:
Tue Feb 26, 2019 2:50 pm
ResearchMed wrote:
Tue Feb 26, 2019 2:32 pm
One thing to consider, in terms of whether "plain vanilla Medicare" is sufficient:
It typically does NOT include medical care outside the USA, so if you are doing - or plan to do - international travel, you'll want some sort of supplemental plan OR be sure to get travel insurance each time you leave the country (and make sure it covers any pre-existing conditions, if any; this is easy to do if one purchases the coverage within a few days of the very first payment/deposit/etc., in which case for most policies there are no exclusions for pre-existing conditions).

RM
As an add on to ResearchMed's post..... Unfortunately, I had an issue overseas that resulted in emergency transport to and two nights in a private hospital in the Ukraine, with the services of both a cardiologist and an ENT. With transport and the first day I had the full time services of a translator and we (wife and I) were provided a two bed private room so she could stay with me. Besides having Medicare my AARP United Plan F picked up 80% of the charges after a $250 deductible was applied. My remaining out of pocket was about $540. .. which would have been the approximate charge for travel insurance for 1 of us.

Just know that the foreign travel benefit on medicare supplement has a 50k lifetime benefit whereas most Medicare Advantage plans have a 90.00 copay for foreign travel emergency with no lifetime limit.
For those who do have the medicare supplement with that 50k lifetime max, it is recommended that one get travel insurance, and make *sure* that it is *primary* coverage (billed first), so that none of the medicare supplement is used up.
Then that $50k is "there" for some unexpected need...

RM
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Shallowpockets
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Re: Medicare choices

Post by Shallowpockets » Tue Feb 26, 2019 3:02 pm

To radio wave.
I have a Kaiser Advantage plan. The core plan. I only pay the '$135 month. It explicitly states I have worldwide emergency care (in bold print). Emergency care is all I would need. Most would only need such a thing. After all, you are not going to go for any routine followups when you are traveling, are you?
As in most every country of the world that may charge you, you would most likely have to foot the bill and seek reimbursement.

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dm200
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Re: Medicare choices

Post by dm200 » Tue Feb 26, 2019 3:13 pm

Julyguy754 wrote:
Tue Feb 26, 2019 1:48 pm
I know it is a personal decision, but I was just wondering if the community had any thoughts on the choice of regular Medicare vs Medicare Advanta
They both have their positive and negative aspects. I'm having a hard time deciding between the two.
I am 64, single, no spouse, have no medical issues at this time, and am not on any medication. I like the lower cost of the advantage , but not the fact my doctor can drop them or the plan drop my doctor, as well as less flexibility and peace of mind knowing what I will pay with the regular Medicare.I would appreciate anyone's thoughts on this.
Thankyou, Julyguy
My wife and I are very happily on a Kaiser medicare plan - our strong opinion is that we get high quality care, high availability to care and low/moderate cost.

If you go with Original Medicare, in my opinion, you must also choose and pay for a supplement (Medigap) to protect against large potential uncovered medical expenses. With Medicare Advantage (MA) plan [or the similar medicare Cost (MC) plan), you have an annual max out of pocket. Most MA plans also include part D coverage.

While one of the most common criticisms of MA plans is more limited access to physicians, that is not always true. In this area, there are many MA plans - many with large numbers of Physicians. In your case, remember that there is no guarantee you can continue to see your doctor under original medicare. There was a recent article I read that MA plan costs to participants, on average, has gone down slightly. Even with the same provider (e.g. Kaiser, Humana, Aetna, etc.) the suitability of MA plans varies immensely.

As to availability of Primary care physicians, our previous PCPs do not take new medicare (original) patients, but are enrolled in MA plans where participants can see these physicians.

cashmoney
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Re: Medicare choices

Post by cashmoney » Tue Feb 26, 2019 3:30 pm

Julyguy754 wrote:
Tue Feb 26, 2019 1:48 pm
I know it is a personal decision, but I was just wondering if the community had any thoughts on the choice of regular Medicare vs Medicare Advanta
They both have their positive and negative aspects. I'm having a hard time deciding between the two.
I am 64, single, no spouse, have no medical issues at this time, and am not on any medication. I like the lower cost of the advantage , but not the fact my doctor can drop them or the plan drop my doctor, as well as less flexibility and peace of mind knowing what I will pay with the regular Medicare.I would appreciate anyone's thoughts on this.
Thankyou, Julyguy


If you have good MA options in your area you may want to try that first.You have a 12 month trial period to test ride a Medicare Advantage where you can revert back to original and be guaranteed a medicare supplement any time in the first 12 months. Some companies like UHC/AARP will extend the guaranteed coverage for medicare supplement to 24 months but you would have to be in an enrollment period to get off the MA plan.

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Stinky
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Re: Medicare choices

Post by Stinky » Tue Feb 26, 2019 4:57 pm

I'll second the positive thoughts about Medicare Advantage. I just got onto Medicare in October of last year, so I'm a newbie, but I've been delighted with my MA so far.

It's provided by our local Blue Cross, who has 98% of the doctors and 100% of the hospitals in the area "in network". I get a free gym membership through Silver Sneakers, get a little benefit for eyeglasses and dental (not available under Medicare). I only deal with Blue Cross, not both Medicare and Medicare Supplement provider. And best of all, I pay no additional premium beyond Part B.

At least where I live, I think that MA is the way to go.
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dm200
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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 9:24 am

Stinky wrote:
Tue Feb 26, 2019 4:57 pm
I'll second the positive thoughts about Medicare Advantage. I just got onto Medicare in October of last year, so I'm a newbie, but I've been delighted with my MA so far.

It's provided by our local Blue Cross, who has 98% of the doctors and 100% of the hospitals in the area "in network". I get a free gym membership through Silver Sneakers, get a little benefit for eyeglasses and dental (not available under Medicare). I only deal with Blue Cross, not both Medicare and Medicare Supplement provider. And best of all, I pay no additional premium beyond Part B.

At least where I live, I think that MA is the way to go.
Yes - we now have a free gym membership as part of our plan as well.

FBN2014
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Re: Medicare choices

Post by FBN2014 » Wed Feb 27, 2019 10:30 am

You will like Medicare Advantage for the lower premiums until you get sick and find out that the specialist doctor you need is not in the network and then the insurance company refuses to pay for the extra physical therapy you need. Then you will wish you had traditional Medicare. Forewarned is forearmed.
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Watty
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Re: Medicare choices

Post by Watty » Wed Feb 27, 2019 10:47 am

Another recommendation for the "Medicare for Dummies" book.
Stinky wrote:
Tue Feb 26, 2019 4:57 pm
At least where I live, I think that MA is the way to go.
Your local options are the key but you need to be cautious since things can change over the next 30 years.

My big concern is that a good MA provider now might not be so good in the future and it would hard to make any changes then. Likewise there is a chance that we may want to move to a different part of the country where there MA plan is not available.
Shallowpockets wrote:
Tue Feb 26, 2019 2:08 pm
The big issue for most people is if they can keep their doctor or not.
This may not be as important as you might think unless you are in the middle of a treatment.

My wife has traditional Medicare and she was able to keep her primary care doctor but within two years he started to phase into retirement and is now only working two days week so it is now much harder to get an appointment with him. He will likely fully retire in a few years.

In some areas it can be hard to find a good new primary care doctor or a specialist that is accepting new medicare patients.

In looking at HMO doctors one comment about the quality was that overall they are pretty good. They may not have some of the top doctors in their field but they also weed out the lowest rated doctors in the field so that balances that out.

I have not started Medicare year and I have not decided which I will use but right now I am leaning towards a MA plan.
Last edited by Watty on Wed Feb 27, 2019 10:50 am, edited 1 time in total.

Shallowpockets
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Re: Medicare choices

Post by Shallowpockets » Wed Feb 27, 2019 10:50 am

FBN2014 wrote:
Wed Feb 27, 2019 10:30 am
You will like Medicare Advantage for the lower premiums until you get sick and find out that the specialist doctor you need is not in the network and then the insurance company refuses to pay for the extra physical therapy you need. Then you will wish you had traditional Medicare. Forewarned is forearmed.
This is not substantiated by anything. What specialist would you need that was not in network? How would you know that specialist in the first place? Are you saying you would want Lindsay Vonn's knee surgery specialist, but that he might not be in network? How realistic is that, because I am sure you could find a Ortho surgeon in network.
People base their medicare choices on co enrage and price, mostly. Then some base it on extreme examples of possible future need. If you are that sort then can and would pay up to cover those extremes.
Last edited by Shallowpockets on Wed Feb 27, 2019 11:17 am, edited 1 time in total.

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Watty
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Re: Medicare choices

Post by Watty » Wed Feb 27, 2019 10:58 am

Shallowpockets wrote:
Wed Feb 27, 2019 10:50 am

This is not substantiated by anything. What specialist would you need that was not in network? How would you know that specialist in the first place? Are you saying you would want Lindsay Vonn's knee surgery specialist, but that he might not be in network? How realistic is that, because I am sure you could find a Ortho surgeon in network.
There is also a good chance that a specialist like that would not take Medicare anyway.

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dm200
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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 11:00 am

Shallowpockets wrote:
Wed Feb 27, 2019 10:50 am
FBN2014 wrote:
Wed Feb 27, 2019 10:30 am
You will like Medicare Advantage for the lower premiums until you get sick and find out that the specialist doctor you need is not in the network and then the insurance company refuses to pay for the extra physical therapy you need. Then you will wish you had traditional Medicare. Forewarned is forearmed.
This is not substantiated by anything. What specialist would you need that was not in network? How would you know that specialist in the first place? Are you saying you would want Lindsay Vonn's knee surgery specialist, but that he might not be in network? How realistic is that, because I am sure you could find a Ortho surgeon in network.
People base their medicare choices on co enrage and price, mostly. Then some base it on extreme examples of possible future need. If you are that sort, the. You can and would pay up to cover those extremes.
Here is an aspect of how I evaluate some of the various health/medical risks and providers/specialists.

1. How likely is it that I will have a condition where I "need" "a" or "the"top specialist/surgeon? I can happen, but I regard this as very unlikely.

2. The much more likely situation is that I need good and economical access to well qualified specialists/surgeons.


I have also come to believe that access to current providers is very overrated. In numerous cases, over the decades, when I had to switch physicians (that I liked very much) because of insurance/network changes, with 20/20 hindsight - more often than not the new physician was just as good or better.

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Re: Medicare choices

Post by nesdog » Wed Feb 27, 2019 11:37 am

I am just a few months from Medicare as I retire in June.

I will be opting for a MA plan. I've been on an HMO plan forever, Kaiser, Healthnet, Blue Cross/Shield, whatever my various employers over the years offered. I've had good and bad doctors on each.

I know one of the advantages touted about Original Medicare is getting a choice of doctors. That doesn't really bother me; how the heck would I even know what doctors to choose anyway? I'd go with a referral from my primary and that would likely be in network.

As it happens, we have a lot of MA plans here in Socal. I'm currently evaluating Kaiser vs Healthnet. Kaiser is the only 5 star plan in the state, but the facilities near us, while really offering good coverage, are also super busy. So I may just stay with HN and my current doc and medical group.
Insert clever comment here...

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Re: Medicare choices

Post by FBN2014 » Wed Feb 27, 2019 12:59 pm

I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
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dm200
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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 1:11 pm

FBN2014 wrote:
Wed Feb 27, 2019 12:59 pm
I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
No expert - but I really doubt that a lot of the "top" folks around the country would be available to almost all of us anyway. Do you really think a regular medicare patient could see (and have medicare pay for), say, Dr James Andrews for a leg or knee problem?

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dm200
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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 1:12 pm

nesdog wrote:
Wed Feb 27, 2019 11:37 am
I am just a few months from Medicare as I retire in June.
I will be opting for a MA plan. I've been on an HMO plan forever, Kaiser, Healthnet, Blue Cross/Shield, whatever my various employers over the years offered. I've had good and bad doctors on each.
I know one of the advantages touted about Original Medicare is getting a choice of doctors. That doesn't really bother me; how the heck would I even know what doctors to choose anyway? I'd go with a referral from my primary and that would likely be in network.
As it happens, we have a lot of MA plans here in Socal. I'm currently evaluating Kaiser vs Healthnet. Kaiser is the only 5 star plan in the state, but the facilities near us, while really offering good coverage, are also super busy. So I may just stay with HN and my current doc and medical group.
That's great you have choices.

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Re: Medicare choices

Post by FBN2014 » Wed Feb 27, 2019 1:17 pm

dm200 wrote:
Wed Feb 27, 2019 1:11 pm
FBN2014 wrote:
Wed Feb 27, 2019 12:59 pm
I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
No expert - but I really doubt that a lot of the "top" folks around the country would be available to almost all of us anyway. Do you really think a regular medicare patient could see (and have medicare pay for), say, Dr James Andrews for a leg or knee problem?
Well, I believe the top hospitals and doctors associated with them do take Medicare, i.e. Johns Hopkins, Cleveland Clinic, Mayo Clinic, M.D. Anderson, etc.
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2015
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Re: Medicare choices

Post by 2015 » Wed Feb 27, 2019 3:21 pm

dm200 wrote:
Wed Feb 27, 2019 1:11 pm
FBN2014 wrote:
Wed Feb 27, 2019 12:59 pm
I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
No expert - but I really doubt that a lot of the "top" folks around the country would be available to almost all of us anyway. Do you really think a regular medicare patient could see (and have medicare pay for), say, Dr James Andrews for a leg or knee problem?
This.
Only a Boglehead would be so overconfident as to think they would have the wherewithal know how to pick and see a "top" specialist.

Not on Medicare yet, but I recently changed PCP's in a new HMO plan after a move and my new PCP is in fact better and more thorough than the old (and the old one was very good).

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Re: Medicare choices

Post by retired_tom » Wed Feb 27, 2019 4:17 pm

I've had Medicare for 4 years now. I chose the AARP UHC Plan F based on my experiences with my Dad. That's the same plan he had, and for the 3 years that he lived with me, in failing health, I took him to Urgent Care centers, ER's, had the EMT's transport him numerous times to the hospital, I can't count the times that he saw doctors, and I never received a bill from anyone. I saw lots of statements from Medicare and UHC, but none of them ever asked us to pay a bill. Sure, it costs a little bit more than some of the MA plans, but it was nice to know that we had complete coverage no matter where and when we needed it.

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Re: Medicare choices

Post by radiowave » Wed Feb 27, 2019 4:27 pm

Shallowpockets wrote:
Tue Feb 26, 2019 3:02 pm
To radio wave.
I have a Kaiser Advantage plan. The core plan. I only pay the '$135 month. It explicitly states I have worldwide emergency care (in bold print). Emergency care is all I would need. Most would only need such a thing. After all, you are not going to go for any routine followups when you are traveling, are you?
As in most every country of the world that may charge you, you would most likely have to foot the bill and seek reimbursement.
Thanks for the follow up, very good to know. We are very happy with Kaiser (CO) and hope to stay with them in a couple years when I retire. Do they cover domestic travel, e.g. I'm on a trip and fall and break something?
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dm200
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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 4:28 pm

2015 wrote:
Wed Feb 27, 2019 3:21 pm
dm200 wrote:
Wed Feb 27, 2019 1:11 pm
FBN2014 wrote:
Wed Feb 27, 2019 12:59 pm
I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
No expert - but I really doubt that a lot of the "top" folks around the country would be available to almost all of us anyway. Do you really think a regular medicare patient could see (and have medicare pay for), say, Dr James Andrews for a leg or knee problem?
This.
Only a Boglehead would be so overconfident as to think they would have the wherewithal know how to pick and see a "top" specialist.

Not on Medicare yet, but I recently changed PCP's in a new HMO plan after a move and my new PCP is in fact better and more thorough than the old (and the old one was very good).
Yes ;)

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dm200
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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 4:31 pm

radiowave wrote:
Wed Feb 27, 2019 4:27 pm
Shallowpockets wrote:
Tue Feb 26, 2019 3:02 pm
To radio wave.
I have a Kaiser Advantage plan. The core plan. I only pay the '$135 month. It explicitly states I have worldwide emergency care (in bold print). Emergency care is all I would need. Most would only need such a thing. After all, you are not going to go for any routine followups when you are traveling, are you?
As in most every country of the world that may charge you, you would most likely have to foot the bill and seek reimbursement.
Thanks for the follow up, very good to know. We are very happy with Kaiser (CO) and hope to stay with them in a couple years when I retire. Do they cover domestic travel, e.g. I'm on a trip and fall and break something?
Also on a Kaiser medicare plan (Wash DC area).

No personal experience, but I believe our Kaiser Medicare plan will cover this.

diy60
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Re: Medicare choices

Post by diy60 » Wed Feb 27, 2019 4:38 pm

dm200 wrote:
Tue Feb 26, 2019 3:13 pm
My wife and I are very happily on a Kaiser medicare plan - our strong opinion is that we get high quality care, high availability to care and low/moderate cost.
dm200, I've seen some of your past informative posts regarding Kaiser MA. Quick question, are there any coverage issues/restrictions if you are out of the area? For example, you live on the east coast and are vacationing in Calif and you have an emergency and hospital stay, is the monetary coverage different from that within your own area? My own bias, I liken MA to that of HMO-type insurance I used to have years ago. Premiums and out of pocket costs were good, but it was somewhat of a hassle to see docs outside of general practitioners, and going out of network was costly. Thanks.

EDIT: looks you may have already responded to someone with a similar question.

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Re: Medicare choices

Post by Nowizard » Wed Feb 27, 2019 5:27 pm

Key issue for us is the frequent comment that Medicare Advantage plans have fewer docs who accept it. However, insurance companies are attempting to move toward those plans due to lower payments for the docs, the reason fewer join the panels. We have never had an issue with any doc not accepting standard Medicare.

Tim

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dm200
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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 5:32 pm

Nowizard wrote:
Wed Feb 27, 2019 5:27 pm
Key issue for us is the frequent comment that Medicare Advantage plans have fewer docs who accept it. However, insurance companies are attempting to move toward those plans due to lower payments for the docs, the reason fewer join the panels. We have never had an issue with any doc not accepting standard Medicare.
Tim
In this area, it is very common that Primary Care Physicians will not accept new Original Medicare patients. Several friends and acquaintances have had great difficulty finding an acceptable to them PCP who will accept them as a new patient. I am sure it is location dependent, but I know several MA plans in this area that have a large number of participating physicians.

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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 5:37 pm

diy60 wrote:
Wed Feb 27, 2019 4:38 pm
dm200 wrote:
Tue Feb 26, 2019 3:13 pm
My wife and I are very happily on a Kaiser medicare plan - our strong opinion is that we get high quality care, high availability to care and low/moderate cost.
dm200, I've seen some of your past informative posts regarding Kaiser MA. Quick question, are there any coverage issues/restrictions if you are out of the area? For example, you live on the east coast and are vacationing in Calif and you have an emergency and hospital stay, is the monetary coverage different from that within your own area? My own bias, I liken MA to that of HMO-type insurance I used to have years ago. Premiums and out of pocket costs were good, but it was somewhat of a hassle to see docs outside of general practitioners, and going out of network was costly. Thanks.
EDIT: looks you may have already responded to someone with a similar question.
I will have to read the "fine print" for the next time we travel, but my understanding is that emergency and urgent care (as you describe) would be covered similarly to what you have in your home area. You would, of course, be expected to contact Kaiser as soon as you could reasonably do so - so that Kaiser can make or coordinate care.

If you are traveling in an area that has Kaiser, then I suspect it would be simpler.

I also suspect that, no matter your coverage, needing medical care while traveling is more of a hassle.

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Re: Medicare choices

Post by HIinvestor » Wed Feb 27, 2019 5:41 pm

I’d carefully read all the plans you’re considering, including the five print. One of the problems with original Medicare is that there is NO limit on out of pocket expenses, so with an expensive hospitalization or regular treatments that can run into a lot of money. Other plans may have some sort of max out of pocket cap, which will limit your out of pocket to a set $$$$ amount.

Your local state Dept of health has an office on aging that can help you weed through all of this. Good luck!

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Re: Medicare choices

Post by dm200 » Wed Feb 27, 2019 5:44 pm

HIinvestor wrote:
Wed Feb 27, 2019 5:41 pm
I’d carefully read all the plans you’re considering, including the five print. One of the problems with original Medicare is that there is NO limit on out of pocket expenses, so with an expensive hospitalization or regular treatments that can run into a lot of money. Other plans may have some sort of max out of pocket cap, which will limit your out of pocket to a set $$$$ amount.

Your local state Dept of health has an office on aging that can help you weed through all of this. Good luck!
Yes! That's why I believe it is essential to have a Medigap plan if you choose Original Medicare.

I believe all Advantage plans have max annual out of pocket limits - so you know the most you would be required to pay in any year.

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Re: Medicare choices

Post by dodecahedron » Thu Feb 28, 2019 6:31 am

dm200 wrote:
Wed Feb 27, 2019 5:32 pm
Nowizard wrote:
Wed Feb 27, 2019 5:27 pm
Key issue for us is the frequent comment that Medicare Advantage plans have fewer docs who accept it. However, insurance companies are attempting to move toward those plans due to lower payments for the docs, the reason fewer join the panels. We have never had an issue with any doc not accepting standard Medicare.
Tim
In this area, it is very common that Primary Care Physicians will not accept new Original Medicare patients. Several friends and acquaintances have had great difficulty finding an acceptable to them PCP who will accept them as a new patient. I am sure it is location dependent, but I know several MA plans in this area that have a large number of participating physicians.
Just because those physicians are ¨participating¨ in a particular MA HMO or PPO plan is also no guarantee that they are accepting new patients!

I learned this the hard way many years ago. We moved our young family to this area and signed up for an HMO plan at my husband´s employer. It had an impressive list of participating physicians including pediatricians. But when I called around all of them were either not accepting new patients or only accepting newborns as new patients. Our older daughter was 3.

End result was that we went with an old-fashioned GP, who treated the whole family. That was okay at first so we stuck with that doc even after our second child was born (when we could have gotten a pediatrician to accept HER since she was a newborn.) But then when second child was a year old, the GP retired. So we scrambled and found a new-fangled ¨family practitioner¨ for the whole family. He was okay but not that great and then suddenly midyear with only a couple weeks warning, he abandoned his private practice to take a job where he could only accept patients from another HMO which we were not eligible for.

Meanwhile second daughter had developed serious issues required pediatric specialty. But she was now 18 month old aand still not a newborn. It took some serious intervention to find a pediatrician to accept my kids.

So just because a doc is on the HMO or PPO list does not mean you can see him or her.

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Re: Medicare choices

Post by dm200 » Fri Mar 01, 2019 9:25 am

Just because those physicians are ¨participating¨ in a particular MA HMO or PPO plan is also no guarantee that they are accepting new patients!
Yes - very true.

However, in the example I used of my former PCP in an MA plan, she was on the accepting new MA patients list.

In our Kaiser Medicare plan, not all PCPs are available to choose all the time. While I have no plan to switch away from my PCP, I occasionally look at available Physicians - just in case. Usually about 1/3 of the PCPs at my center are available to choose - and the specifics change regularly.

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Re: Medicare choices

Post by doubledoodles » Fri Mar 01, 2019 10:31 pm

Question: Slightly off topic

I turn 65 this year but intend to continue working another 2 1/2 years. My wife and I are covered under her Employer's plan and we will continue to be so covered until we retire (I'll be 67, she 66). My question is whether I have to some how register or sign up for Medicare this year when I turn 65, even though I will not buy it or use it for a couple more years?

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Re: Medicare choices

Post by Carol88888 » Sat Mar 02, 2019 3:12 am

If you get really sick and need a difficult surgery I would think you would want to find the best surgeon at the best hospital. An Advantage plan will limit you to their list of surgeons at their hospital. I think this is a terrible idea.

So I went with regular Medicare and a cheap supplemental plan from AARP. It gives me coverage for 90% and that's good enough for me.

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Re: Medicare choices

Post by skp » Sat Mar 02, 2019 10:45 am

My experience as a RN is that MA plans don't cover rehab as well as traditional Medicare with a supplement. I would place an insurances coverage of rehab as a high priority in my decision.

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Re: Medicare choices

Post by GerryL » Sat Mar 02, 2019 1:38 pm

doubledoodles wrote:
Fri Mar 01, 2019 10:31 pm
Question: Slightly off topic

I turn 65 this year but intend to continue working another 2 1/2 years. My wife and I are covered under her Employer's plan and we will continue to be so covered until we retire (I'll be 67, she 66). My question is whether I have to some how register or sign up for Medicare this year when I turn 65, even though I will not buy it or use it for a couple more years?
If you are on a high-deductible plan and use a health savings account you DO NOT want to sign up for any part of Medicare. No contributions to an HSA are allowed after you have signed up for Medicare. And be aware that once you sign up for Medicare after you have passed the age of 65, the restriction on HSA contributions is retroactive to your 65th birthday or 6 months, whichever is shorter.

If you are not using an HSA, you could sign up for Part A, which used to be conventional wisdom. (I did that and soon after my employer pushed employees into high-deductible plans What a mess to undo the Medicare sign up.)

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Re: Medicare choices

Post by annebert » Sat Mar 02, 2019 2:20 pm

doubledoodles wrote:
Fri Mar 01, 2019 10:31 pm
Question: Slightly off topic

I turn 65 this year but intend to continue working another 2 1/2 years. My wife and I are covered under her Employer's plan and we will continue to be so covered until we retire (I'll be 67, she 66). My question is whether I have to some how register or sign up for Medicare this year when I turn 65, even though I will not buy it or use it for a couple more years?
I agree that understanding your HSA options is important. The other thing you have to worry about is being penalized on Part B costs permanently for not registering for Part A and Part B at 65. However, I found this information (from Motley Fool): If you're still working and have health care through your employer (or covered by a spouse's plan) by the time you turn 65, you don't need to sign up for Medicare at that time -- and you don't have to worry about the aforementioned Part B penalty, either. As long as your spouse's company employs 20 people or more, you can hold off on Medicare and stay on the company's group plan for as long as it remains available to you.

I'm not sure about where that "20 people or more" limitation comes from - you might want to investigate this a bit more - maybe your wife's HR can doublecheck that you'll be ok.

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Re: Medicare choices

Post by dm200 » Sun Mar 03, 2019 3:13 pm

Carol88888 wrote:
Sat Mar 02, 2019 3:12 am
If you get really sick and need a difficult surgery I would think you would want to find the best surgeon at the best hospital. An Advantage plan will limit you to their list of surgeons at their hospital. I think this is a terrible idea.
So I went with regular Medicare and a cheap supplemental plan from AARP. It gives me coverage for 90% and that's good enough for me.
I certainly see the point, BUT - one (of many) question is what percentage of "THE BEST" surgeons at "THE BEST" hospitals will BOTH accept Original Medicare AND be available to do surgery on "regular folks"?

Any "regular folks" Bogleheads with any experiences with "THE BEST" surgeons at "THE BEST" hospitals?

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Re: Medicare choices

Post by 123 » Sun Mar 03, 2019 3:27 pm

Your choice could depend on what insurance you presently have (if any). Just find out what coverage options are available from your present insurer when you go on Medicare. They may have a Medicare Advantage or Medigap coverage available similar to your existing coverage. In some areas Medicare Advantage is free. We have two relatives who have the same Medicare Advantage provider in different areas, uncle has to pay for his but aunt gets hers for free (No Medicaid involvement). However Medicare Advantage can complicate future insurance choices.
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Re: Medicare choices

Post by radiowave » Sun Mar 03, 2019 3:37 pm

doubledoodles wrote:
Fri Mar 01, 2019 10:31 pm
Question: Slightly off topic

I turn 65 this year but intend to continue working another 2 1/2 years. My wife and I are covered under her Employer's plan and we will continue to be so covered until we retire (I'll be 67, she 66). My question is whether I have to some how register or sign up for Medicare this year when I turn 65, even though I will not buy it or use it for a couple more years?
Be sure you get a copy of Form 1095-C Employer-Provided Health Insurance as documentation you had coverage for the two years prior to full Medicare at 67. At 65, as I understand, you need to apply for Medicare Part A (no cost) and if you have insurance from employer, that will cover Part B. The problem is if you defer Part B (monthly cost) and don't have the documentation you were covered, there are consequences when you try to apply for Part B after 65. I don't know all the nuances - yet - as I have a couple years to go, but understand having a copy of that form is important when you work past 65 and have healthcare insurance.
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Re: Medicare choices

Post by 2015 » Mon Mar 04, 2019 1:56 pm

Carol88888 wrote:
Sat Mar 02, 2019 3:12 am
If you get really sick and need a difficult surgery I would think you would want to find the best surgeon at the best hospital. An Advantage plan will limit you to their list of surgeons at their hospital. I think this is a terrible idea.

So I went with regular Medicare and a cheap supplemental plan from AARP. It gives me coverage for 90% and that's good enough for me.
Singer Peter Tork died recently. Actor Luke Perry died this week at age 52. People get sick. People die. Nature plays no favorites when it comes to sickness and health.

I think it's a terrible idea for a BH to apply their same pathological search for certainty in investing to their health care. One's physiology and biology (just like investing) exist in a complex adaptive system with unknown and unknowable inputs and outcomes. That feel good story of the week you read in [fill in the blank] about the individual who "beat cancer" is an example of invisibility bias (among others). The "best" surgeon in the "best" hospital if you can even get in to see them may or may not save you. Luck good and bad inserts itself into all outcomes. You can attempt to seduce luck through your efforts, but IMO it's a mistake to use that as a basis for medical plan selection.

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Re: Medicare choices

Post by dm200 » Mon Mar 04, 2019 2:44 pm

123 wrote:
Sun Mar 03, 2019 3:27 pm
Your choice could depend on what insurance you presently have (if any). Just find out what coverage options are available from your present insurer when you go on Medicare. They may have a Medicare Advantage or Medigap coverage available similar to your existing coverage. In some areas Medicare Advantage is free. We have two relatives who have the same Medicare Advantage provider in different areas, uncle has to pay for his but aunt gets hers for free (No Medicaid involvement). However Medicare Advantage can complicate future insurance choices.
Yes -

I have noticed that there are several "trends" for retirees of some employers regarding health/insurance in retirement (after Medicare eligibility at age 65):

1. Many (especially in the private sector) have gone to ZERO benefits for such retirees. This is true for even those private employers which once provided super coverage.

2. Some (seems to be government or school systems mostly) employers only provide such retiree benefits if and only if the retiree chooses a particular (customized to that employer) Medicare Advantage plan. If the retiree wishes Original medicare, the retiree forfeits quite a benefit. One of the risks of "regular" MA plans is a significant (mine is $6,700 per year) max out of pocket potential. These customized MA plans, though, that I have seen reduce this or eliminate it.

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Re: Medicare choices

Post by Carol88888 » Fri Mar 08, 2019 2:10 pm

Okay, maybe I overstated my position about "the surgeon" at the best hospital. What I mean to say is that there are times when someone needs a difficult surgery and when it matters greatly that a surgeon be selected who has done the procedure many times with good outcomes. This information is available and I certainly would want to use it if I were facing such a surgery.

As for hospitals, I live in NYC with Sloan Kettering. Why would I want to limit myself to one of the other hospitals (good as they might be) if I were facing a rare cancer that was difficult to treat?

People who have access to the Mayo Clinic or the Cleveland Clinic would also be disadvantaged if they chose an Advantage plan that might preclude them for using those great facilities.

Yes, Advantage plans might be cheaper but you have to look into why they are cheaper and what you give up to get cheaper.

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Re: Medicare choices

Post by dm200 » Fri Mar 08, 2019 2:24 pm

Carol88888 wrote:
Fri Mar 08, 2019 2:10 pm
Okay, maybe I overstated my position about "the surgeon" at the best hospital. What I mean to say is that there are times when someone needs a difficult surgery and when it matters greatly that a surgeon be selected who has done the procedure many times with good outcomes. This information is available and I certainly would want to use it if I were facing such a surgery.
As for hospitals, I live in NYC with Sloan Kettering. Why would I want to limit myself to one of the other hospitals (good as they might be) if I were facing a rare cancer that was difficult to treat?
People who have access to the Mayo Clinic or the Cleveland Clinic would also be disadvantaged if they chose an Advantage plan that might preclude them for using those great facilities.
Yes, Advantage plans might be cheaper but you have to look into why they are cheaper and what you give up to get cheaper.
Yes - a valid point to evaluate. What is that probability? Not zero, of course, but I suspect very low. A tradeoff, depending on details of MA plan, is not just financial (in my opinion). Some Advantage plans (such as mine) have great convenience for a wide range of conditions and (in my opinion) great access to "qualified" providers, surgeons, hospitals, etc.

In discussing various choices friends and acquaintances have made for their care and options under Medicare, my wife and I have concluded that we have very convenient and quick access to just about any kind of issue we might face. Such friends and acquaintances often need to expend time and effort to locate a provider/specialist and, once located, may need to wait weeks for an appointment. In our opinion and experience, we get such appointments very, very quickly and need spend zero time looking for a specialist/provider. Our plan does that. [We also have lower costs to us]

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Re: Medicare choices

Post by Carol88888 » Fri Mar 08, 2019 4:24 pm

And it is not even the best surgeon or the best hospital that might be off limits. Medicine is becoming more specialized with gene therapy treatments on the horizon. Most of the newer, innovative medicines are exorbitantly expensive.

Your Advantage plan - which acts somewhat like a HMO - by limiting choices - may also have reason to keep you from getting expensive,cutting edge treatments by calling them "experimental."

And this happens not only in the realm of drugs. Prostrate cancer now has a superior treatment in the form of Cyberknife, a targeted radiation treatment that requires only 5 days of 15 minute treatments as opposed to the older 6 weeks of treatments. Or surgery with its risks of incontinence or impotence.

But since the older methods work - albeit with bad side effects - there could be a way the Advantage plan might say they are "sufficient" - especially since Cyberknife is costy. ($250,000 without insurance)

Same thing with heart surgery. There are now ways to avoid open heart surgery by repair a valve through a cathered. It's new . It's expensive. Will you be covered if you want it?

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Re: Medicare choices

Post by orlandoman » Fri Mar 08, 2019 6:17 pm

Doctors have three Medicare choices (whether they accept you as a new patient or not):
- do not accept Medicare
- ‘participate’ in Medicare
- ‘accept’ Medicare assignments

Medicare Supplements:
- there are standardized supplements, each with a letter name, i.e. ‘F’, ‘N’, etc.
- not all supplements may be offered by insurance company
- each specific letter named plan has the exact same benefits
- you need to get services from any provider that either participates in Medicare or accepts assignments

Medicare Advantage:
- MA plans are available as HMO’s & PPO’s
- each insurance carrier may offer HMO’s or PPO’s at their choice
- there is no required standardization of HMO or PPO plans
- each carrier may offer multiple HMO or PPO plans in the same area, each with different benefits
- many/most MA plans include Part D drug benefits
- benefits may include limited vision & dental benefits & free gym memberships & benefits may change on an annual basis
- HMO’s & PPO’s normally have copays or deductibles & an out of pocket maximum
- HMO’s have a network & normally only emergency care is offered out of network
- PPO’s have a network & out of network services are available with a higher copay or deductible
- PPO’s services out of network, you need to get services from any provider that either participates in Medicare or accepts assignments (same as supplements) & accepts you as a new out of network patient

As an example, I have a MA PPO plan. I have no monthly premium. I pay $10 to see my personal physician (in network). I see a dermatologist (specialist) out of network & pay $70 per visit, if I went to an in network dermatologist it would be $30. It is my personal choice to see an out of network specialist, there are plenty of in network dermatologists available. There are in & out of network out of pocket maximums. I live in Central FL, an area with many plan choices.

Like the saying from real estate, "location, location, location". Where you live will determine your options.
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