Medicare coverage insurers

Need to express some concerns. Was steered to a Humana Medicare”No extra Cost” program by my retirement employer brokerage. Sell was not really hard, the coverages sounded good not great but the draw of no extended premium by the broker got me. Is a scam, typical insurance double speak. Have to have receptive medical associations and physicians to buy into the reduced pricing, to which I have found next to none. Out Of Pocket expenses to apply to deductibles are only for ‘covered’ procedures or processes and in only those medical suppliers accepting their fees schedules.

So I am hung out to dry until October when the markets re-open to allow swapping to another service provider.

So far this month over $500 not covered costs as the providers are Not ‘in
Network’ and are no providers they can furnish as replacement as no one performing said services accept their fees schedules.

HUMANA is a Scam

Edited by DMiller - 18 Feb 2023 at 7:31am

50% of seniors are on Medicare "ADVANTAGE PLANS"... This is a Private run Medicare Program that gets your premium that you pay the GOVT every month ( about $160.) and also part of the money you have paid to the GOVT for the past 40 years for MEdicare..

Edited by steve(ill) - 18 Feb 2023 at 8:28am

not much different than STANDARD MEDICARE... Thats why they have the EXTENDED B PLAN that you can buy from "OTHERS"... that covers the cost when STANDARD MEDICARE does not pay past Plan B basics.

It comes down to the SMALL PRINT - and the overall plan . 
I talked to several individuals who had plans and most seemed happy with them - UNTIL a few years back when the TV adds started pushing the Get Money back (this was for a couple areas in NY State and special exemption) but slick adds are now (I hate to say it SUCKERING PEOPLE who are retired) next to outright FRAUD .
  Back in 2014 when wife passed I had Ucare MN and I got a final breakdown for her medical for her last 8 months $940,000 - Ucare and Medicare negotiated cost savings brought figure to $520,000 or so . Part D prescription drug costs she had hit the Donut Hole in March of that year so had some extra costs there I had to pay .
 She had cataracts removed from both eyes and new glasses , (no co pay) , 3 hospital stays , 3 stays in recovery care facilities , then Hospice care . My total I paid was under $5,000 for all services provided to her .
  I have nothing but good to say about the care and coverage she was given under Ucare MN . I did have some problems with recovery care provider that i voiced but it was not insurance fault - it was lousy staffing and their policies . On speaking to them about problems, they reduced their rate to semi-private room from the single room she had . 
  I get one statement each month listing all charges , what they paid , what I might owe and this is for Doctor, Outside referrals , and drug costs - showing billed services , what Medicare will allow and what Ucare paid - and what I might owe . 
  On Part D most pharmacies run the meds through Ucare when I turn in prescription so what i might own I pay when picking up .
  Drug costs are the big one now Doctor wanted me to take ELOQUIS - cost per month is $1,346 / Insurance says $141 a month for 11 month but first month has a buy in of $580 you need to pay outright .
  I would say get All coverage under 1 plan  - All Advantage plan under same company . 
NOW TO CHANGE PLANS outside the lock in times you could change your address to another area and choose a new carrier  

Am on a Retirement company sponsored brokerage system, only option is during fall open market.

Remember the words of Joe B who said others want to cut your Medicare . 
Well it seems as part of Budget Reduction Act - a 4% reduction to what is paid to hospitals and doctors was  hidden in it - now it's refigured to be 2% after someone on other side of isle hollered FOUL 
 What is going to happen is Doctors are going to STOP accepting Medicare or any form of Insurance that deals with it and Companies will be raising premiums or have such lousy policies you will not realize - the insurance is worthless and wont pay . 

Every year Medicare sends out a book for your state listing all the plans that Medicare works with , what they cover , what the cost is , listed with or without Part D . 
  I looked at several plans and thought of changing but on review of present plan will keep it . I did take out higher dental insurance as basic covers routine exams and 2 cleanings a year . Plan i have is $25 a month but has copay for fillings , no charge for x rays , and covered the denture I got at 70% but as I had some extractions those cost capped out the $2500 policy .  

Dave, you should be argueing with Humana.... "BY LAW" the Advange plans have to cover the same thing that Medicare covers.... Govt requires that....... now SUPPLEMENTS will get you MORE than the standard plan, but if you pay for the PREMIUM Advantage plans, they compete with the Supplement plans.

Advantage plans HAVE TO COVER THE SAME AS MEDICARE... That is THE LAW..

thats my point.. Seems to be a HUMANA problem ...... i have had ZERO problems with Aetna... coverage actually BETTER than Medicare and Supplement ...as Aetna added $1000. coverage for Dental, and i think $500. for Hearing and Eyes.... and MY cost is $0. per month. ... plus they give me $75. credit every 3 months to buy "pharmacy related items". ...... band aids, cough meds, soap, shampoo, dental, etc..

Edited by steve(ill) - 26 May 2023 at 9:10am

Just got my Invoice for UCare MN for 2024 - it went down to $38 for the medical insurance (includes Part D coverage) and dental supplement through Delta Dental stayed at $25 .
  Big difference came in in 2024 all drug costs are at 0 co pay for drugs in Tier 1, 2 , 3 and the tier 4 drugs are at way lower rates . Elequis dropped to $100 for 30 day and no first month payment of the $511 added so big reduction .
  UCare reimbursed me $150 on eye glasses and covered exam fully . this was 2023 rate . Did see a big jump in prices on from last pair 2 years back even with Sam's Club discount of 20% on total bill . 

OH MAN,,,I'm sure not looking forward to signing up for this in ~ a year and half,,,,sounds like all about clear as muddy water...

Its all a scam, BUT that is what we are stuck with. I get the policy thru a financial advisor that does part b on the side. He finds the beast deals and every couple years he finds a different place. I think the last 2 years it is humana, --- I dont mess with it myself,---dont understand any of it!

Mike, each company is a little different, but  "I THINK" that the IN NETWORK is they pay 80% and YOU pay 20% .... Out of NETWORK it might be 70% - 30% ..... but once you hit "THE LIMIT" like $4500. then your OUT and they pay EVERYTHING after that ... That is the MEDICAL... if you dont have "dental" and then need something large, of course they are not paying for that.

Edited by steve(ill) - 21 Dec 2023 at 12:43pm

Most Advantage Plans have extended coverage , it might be called out of network , but still covered - the same as with Medicare Standard . 
 Ucare MN is a NON PROFIT - not a Corp with share holders so rates tend to be a lot lower in these types of companies .  
 All policies for seniors - revert to Medicare for Hospice care -