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Looking to change insurance

after 10 years

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#1 LPPT

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Posted 06 November 2015 - 07:01 AM

I am looking at changing insurance.

I know I want an HMO that pays before deductible.

I am looking for one that works well with the Wellstar system.

I need an HMO because I am followed for chronic conditions.

I am looking at a BCBS plan.

I think the majority of doctors take BCBS because it is the dominant insurance company in Ga., not especially the best but I need access to a larger pool of doctors and specialist than my current insurance company offers.

So I need the pros and cons of their HMO, especially as it pertains to Wellstar.

I did not see where the Wellstar system is offering a direct HMO to their system, as if BCBS would allow that anyway.

 


El Zorro

 

As far as releasing my name here, it's not going to happen.  There have been people here who found someone's given name and then found where they worked and made things difficult for them - all because they didn't like them here because of their political opinions.

 


#2 lowrider

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Posted 06 November 2015 - 11:00 AM

Have you thought about a PPO?  That's what I've had for years and have kept all of my doctors in the Wellstar system.

 

First I was with BC/BS.  I had to change when I turned 65 because AT&T drops all of their folks at 65.   I'm now with Aetna,  another PPO and have kept all of my doctors.



#3 DallasRED

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Posted 06 November 2015 - 11:53 AM

Have you thought about a PPO?  That's what I've had for years and have kept all of my doctors in the Wellstar system.

 

First I was with BC/BS.  I had to change when I turned 65 because AT&T drops all of their folks at 65.   I'm now with Aetna,  another PPO and have kept all of my doctors.

I thought you had to go on Medicare at age 65? That is how Tricare works. They pay what Medicare doesn't.


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#4 lowrider

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Posted 06 November 2015 - 11:55 AM

I still need a supplemental with Medicare.



#5 lowrider

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Posted 06 November 2015 - 12:02 PM

And even though I retired from AT&T (formally Bellsouth) I had to pay for my insurance.  When I first retired, my monthly premiums were $10 for BC/BS, including coverage for my husband, including vision and dental.

 

When Obama care became effective, my premiums went up to $120 a month.  The next year they went up to around $150.

 

Now that I'm 65 AT&T drops their employees but routes us through a contractor called AON to help us find the best policy for our situation.

 

Aetna was the best plan for my needs and it includes a prescription plan.  It does not include vision or dental.  I have to purchase dental seperately.  I don't need vision since I don't wear glasses.  I use Medicare to get a yearly check up from an opthomalogist.



#6 ApolloBeachRetiree

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Posted 06 November 2015 - 12:13 PM

I am looking at changing insurance.

I know I want an HMO that pays before deductible.

I am looking for one that works well with the Wellstar system.

I need an HMO because I am followed for chronic conditions.

I am looking at a BCBS plan.

I think the majority of doctors take BCBS because it is the dominant insurance company in Ga., not especially the best but I need access to a larger pool of doctors and specialist than my current insurance company offers.

So I need the pros and cons of their HMO, especially as it pertains to Wellstar.

I did not see where the Wellstar system is offering a direct HMO to their system, as if BCBS would allow that anyway.

 

Laurie, both my wife and I are with Florida Blue. If you want the most flexible network, you want a PPO plan. This gives you access to more doctors and, in our experience here, many doctors do not accept HMO plans but do accept PPO plans. Amy has two chronic conditions and a Florida Blue Blue Options PPO plan was the only way to go. Hers for 2016  is the FL Blue Options 1410 (silver); I do not know the plan numbers in Georgia.

 

Ask any questions that come to mind and I'll try to help.

 

Caveat - be prepared for premium shock.


Edited by ApolloBeachRetiree, 06 November 2015 - 12:14 PM.

Hillary was a terrible candidate. Plain and simple.

 

The Hildabeast IS a despicable CESSPOOL of CORRUPTION.


#7 FreeBird

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Posted 06 November 2015 - 12:19 PM

Kaiser HMO was the best insurance I had and kept for over 20 years until the Affordable Care Act made it affordable for me (and I couldn't keep the doctor that I liked.)  I don't know if that type of HMO is even available today.  I would think the closest you can get to is to have low deductible which means really high monthly premium - or was it supposed to be $75 a month?  With all the lies Obama told on this one it is hard to keep them all straight.  All I know is I pay more for less.

 

Hope you can find something that works for you.


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#8 DallasRED

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Posted 06 November 2015 - 12:22 PM

And even though I retired from AT&T (formally Bellsouth) I had to pay for my insurance.  When I first retired, my monthly premiums were $10 for BC/BS, including coverage for my husband, including vision and dental.

 

When Obama care became effective, my premiums went up to $120 a month.  The next year they went up to around $150.

 

Now that I'm 65 AT&T drops their employees but routes us through a contractor called AON to help us find the best policy for our situation.

 

Aetna was the best plan for my needs and it includes a perscription plan.  It does not include vision or dental.  I have to purchase dental seperately.  I don't need vision since I don't wear glasses.  I use Medicare to get a yearly check up from an opthomalogist.

When DH was Active duty Healthcare was free, now that he is retired we pay for Tricare. Once he turns 65 it is free again, but we have to pay for Medicare Part B.


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#9 ApolloBeachRetiree

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Posted 06 November 2015 - 12:26 PM

Kaiser HMO was the best insurance I had and kept for over 20 years until the Affordable Care Act made it affordable for me (and I couldn't keep the doctor that I liked.)  I don't know if that type of HMO is even available today.  I would think the closest you can get to is to have low deductible which means really high monthly premium - or was it supposed to be $75 a month?  With all the lies Obama told on this one it is hard to keep them all straight.  All I know is I pay more for less.

 

Hope you can find something that works for you.

I had Kaiser HMO for years but they don't offer services in Florida. Kaiser is the only HMO I would consider since almost all of their network is in-house.

 

What I have had to do here to lower the outrageous premiums (as big as mortgage payments), is to enroll Amy in a plan with higher deductibles, out of pocket and copays. Otherwise, I would have to sell our house to afford the premiums.


When DH was Active duty Healthcare was free, now that he is retired we pay for Tricare. Once he turns 65 it is free again, but we have to pay for Medicare Part B.

Let me know if he has any questions on SS and Medicare. Been there for both.


Hillary was a terrible candidate. Plain and simple.

 

The Hildabeast IS a despicable CESSPOOL of CORRUPTION.


#10 DallasRED

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Posted 06 November 2015 - 12:28 PM

I had Kaiser HMO for years but they don't offer services in Florida. Kaiser is the only HMO I would consider since almost all of their network is in-house.

 

What I have had to do here to lower the outrageous premiums (as big as mortgage payments), is to enroll Amy in a plan with higher deductibles, out of pocket and copays. Otherwise, I would have to sell our house to afford the premiums.


Let me know if he has any questions on SS and Medicare. Been there for both.

We are only in our 40's, got a long way to go.


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Posted Image

"Why are some people such assholes for no reason but then are the first to bitch to the mods when the tables are turned" GO BLUE

"You judge me and think you know me, and I'm quite sure we've never met. You know nothing." MADEA

"NOT ONE DAMN ONE OF YOU HAS THE RIGHT TO TELL ME I CAN NOT FEEL THE WAY I DO." SOLO

#11 LPPT

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Posted 06 November 2015 - 01:09 PM

Do PPO's pay anything before the deductible is met?


El Zorro

 

As far as releasing my name here, it's not going to happen.  There have been people here who found someone's given name and then found where they worked and made things difficult for them - all because they didn't like them here because of their political opinions.

 


#12 lowrider

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Posted 06 November 2015 - 01:16 PM

My doctor visits are $7 and a specialist is $39. If I have testing or procedures I have a $300 deductible. But my Medicare picks up a lot as its my primary insurance.

#13 ApolloBeachRetiree

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Posted 06 November 2015 - 01:17 PM

Do PPO's pay anything before the deductible is met?

They pay in the same manner as HMOs; the difference if the breadth of the network. With a PPO, you do not need a referral from your PCP.

 

However, I would suggest calling Blue Cross - or - contact one of their insurance agents in the area. That's what we did to help us through choosing the best plan for Amy and to enroll us in the marketplace. 


Hillary was a terrible candidate. Plain and simple.

 

The Hildabeast IS a despicable CESSPOOL of CORRUPTION.


#14 ApolloBeachRetiree

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Posted 06 November 2015 - 01:21 PM

My doctor visits are $7 and a specialist is $39. If I have testing or procedures I have a $300 deductible. But my Medicare picks up a lot as its my primary insurance.

You have an Aetna Medicare Advantage plan, right? That means that Aetna handles all billing, including interfacing with Medicare (a blessing for sure). 

 

My Florida Blue plan is also a Medicare Advantage plan but is a PPO so that I get the broader network.

 

Medicare will cover many vision needs. I can share what I've been through if you are curious.


Hillary was a terrible candidate. Plain and simple.

 

The Hildabeast IS a despicable CESSPOOL of CORRUPTION.


#15 jenilyn

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Posted 06 November 2015 - 01:29 PM

I have an HMO and I'm having a hard time finding a doctor who will accept it.
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#16 lowrider

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Posted 06 November 2015 - 01:30 PM

Yes. And it's also a PPO. I would never subject myself to an HMO. LOL

I like to have control over my care.

#17 ApolloBeachRetiree

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Posted 06 November 2015 - 01:51 PM

I have an HMO and I'm having a hard time finding a doctor who will accept it.

Exactly why you need to change your plan to a PPO in 2016.


Hillary was a terrible candidate. Plain and simple.

 

The Hildabeast IS a despicable CESSPOOL of CORRUPTION.


#18 LPPT

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Posted 06 November 2015 - 02:04 PM

I guess I am going to have to educate myself on how PPO's work.

Can someone give me a little synapses?

I have been with Kaiser for so long.

My doctor is leaving and I am looking to follow him.

I don't want pain management from a clinic or a doctor I don't trust and does not trust me not to abuse my medication.

The Lyme has also gotten progressively worse and I had a horrible experience with their infectious disease specialist.

I have always been afraid of getting a serious cancer and being forced to use their doctors or bankrupt my family.

The reason I am looking at HMO is the frequency of visits to follow me for both can get extremely expensive if you have to meet a deductible before they pay. I of course have prescriptions filled every month.

If I have to have intravenous treatment for Lyme we are talking a lot of money. I am almost bedridden at this point and it is a horrible time to look at changing insurance and if not changing Dr.s by the first of the year.

This is a huge decision with me being so seriously ill.


I have an HMO and I'm having a hard time finding a doctor who will accept it.

I had thought Wellstar was going to have their own HMO.


El Zorro

 

As far as releasing my name here, it's not going to happen.  There have been people here who found someone's given name and then found where they worked and made things difficult for them - all because they didn't like them here because of their political opinions.

 


#19 ApolloBeachRetiree

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Posted 06 November 2015 - 02:35 PM

I guess I am going to have to educate myself on how PPO's work.

Can someone give me a little synapses?

I have been with Kaiser for so long.

My doctor is leaving and I am looking to follow him.

I don't want pain management from a clinic or a doctor I don't trust and does not trust me not to abuse my medication.

The Lyme has also gotten progressively worse and I had a horrible experience with their infectious disease specialist.

I have always been afraid of getting a serious cancer and being forced to use their doctors or bankrupt my family.

The reason I am looking at HMO is the frequency of visits to follow me for both can get extremely expensive if you have to meet a deductible before they pay. I of course have prescriptions filled every month.

If I have to have intravenous treatment for Lyme we are talking a lot of money. I am almost bedridden at this point and it is a horrible time to look at changing insurance and if not changing Dr.s by the first of the year.

This is a huge decision with me being so seriously ill.


I had thought Wellstar was going to have their own HMO.

Kaiser is unique. No other healthcare plan or provider looks like Kaiser.

 

I did find this comparison between an HMO and a PPO:
 


Health Maintenance Organizations (HMOs)

If you are enrolled in a health maintenance organization (HMO) you will need to receive most or all of your health care from a network provider. HMOs require that you select aprimary care physician (PCP) who is responsible for managing and coordinating all of your health care.

Your PCP will serve as your personal doctor to provide all of your basic healthcare services. PCPs include internal medicine physicians, family physicians, and in some HMOs, gynecologists who provide basic healthcare for women. For your children, you can select a pediatrician or a family physician to be their PCP.

If you need care from a physician specialist in the network or a diagnostic service such as a lab test or x-ray, your primary care physician (PCP) will have to provide you with a referral.

If you do not have a referral or you choose to go to a doctor outside of your HMO's network, you will most likely have to pay all or most of the cost for that care.

Preferred Provider Organizations (PPOs)

A preferred provider organization (PPO) is a health plan that has contracts with a network of "preferred" providers from which you can choose.

 

You do not need to select a PCP and you do not need referrals to see other providers in the network.

If you receive your care from a doctor in the preferred network you will only be responsible for your annual deductable (a feature of some PPOs) and a copayment for your visit. If you get health services from a doctor or hospital that is not in the preferred network (known as going "out-of-network") you will pay a higher amount. And, you will need to pay the doctor directly and file a claim with the PPO to get reimbursed.

How HMOs and PPOs Differ

The following outline compares some of the features of HMOs and PPOs. These are general rules and you should speak with your human resources office at work or directly with your health plan. If you are in the process of deciding between enrolling in a HMO or PPO, you often can compare the plans by going online to the plans' websites to learn about the available benefits and costs.

Which health care providers must I choose?

  • HMO: You must choose doctors, hospitals, and other providers in the HMO network.
  • PPO: You can choose doctors, hospitals, and other providers from the PPO network or from out-of-network. If you choose an out-of-network provider, you most likely will pay more.

Do I need to have a primary care physician (PCP)?

  • HMO: Yes, your HMO will not provide coverage if you do not have a PCP.
  • PPO: No, you can receive care from any doctor you choose. But remember, you will pay more if the doctors you choose are not "preferred" providers.

How do I see a specialist?

  • HMO: You will need a referral from your PCP to see a specialist (such as a cardiologist or surgeon) except in emergency situations. Your PCP also must refer you to a specialist who is in the HMO network.
  • PPO: You do not need a referral to see a specialist. However, some specialists will only see patients who are referred to them by a primary care doctor. And, some PPOs require that you get a prior approval for certain expensive services, such as MRIs.

Do I have to file any insurance claims?

  • HMO: All of the providers in the HMO network are required to file a claim to get paid. You do not have to file a claim, and your provider may not charge you directly or send you a bill.
  • PPO: If you get your healthcare from a network provider you usually do not need to file a claim. However, if you go out of network for services you may have to pay the provider in full and then file a claim with the PPO to get reimbursed. The money you receive from the PPO will most likely be only part of the bill. You are responsible for any part of the doctor's fee that the PPO does not pay.

How do I pay for services in the network?

  • HMO: The only charges you should incur for in-network services are copayments for doctor's visits and other services such as procedures and prescriptions.
  • PPO: In most PPO networks you will only be responsible for the copayment. Some PPOs do have an annual deductable for any services, in network or out of network.

How do I pay for services out of the network?

  • HMO: Except for certain types of care that may not be available from a network provider, you are not covered for any out-of-network services.
  • PPO: If you choose to go outside the PPO network for your care, you will need to pay the provider and then get reimbursed by the PPO. Most likely, you will have to pay an annual deductable and coinsurance. For example, if the out-of-network doctor charged you $200 for a visit, you are responsible for the full amount if you have not met your deductible. If you have met the deductible, the PPO may pay 60%, or $120 and you will pay 40%, or $80.

Also, here is a good reference for HMO vs PPO:

https://www.humana.c...lans/hmo-vs-ppo


Edited by ApolloBeachRetiree, 06 November 2015 - 02:34 PM.

Hillary was a terrible candidate. Plain and simple.

 

The Hildabeast IS a despicable CESSPOOL of CORRUPTION.


#20 confederaterose

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Posted 06 November 2015 - 02:59 PM

It is now so complicated that it hard to understand.  My daughter had Obamacare last year with Blue Cross.  Wellstar Kennestone and non of her doctors would accept it.  She went with Kaiser this year and loves it.  The last I heard you could not buy Kaiser in Paulding, because, they do not have an office here.

 

I am retired from USAA.  They have always provided out insurance at a very nominal cost to me.  Under the new rules of Obamacare, they could not do that or the premiums would increase 285%. For 2016, we have to buy our supplement on the open market. They did put prices and coverage on their website.  I compared the prices on every one listed. A supplement F, with drug coverage was $180 per month for me and $180 for hubby, of course no co-payments and no deductibles.  I, also, compared all the HMO's and PPO's.  When you entered your doctors names, it would tell you if they took the insurance.  When I entered the medication in the medicine cabinet, it told me the co-payment for each medication. I ended up going with an Aetna PP0, which sounds like the one Lowrider has.  I hope I made the right decision.

 

If you are a USAA member, you can go on their website, look under heath insurance and compare what and who each covers and for what cost. 



#21 ApolloBeachRetiree

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Posted 06 November 2015 - 03:04 PM

It is now so complicated that it hard to understand.  My daughter had Obamacare last year with Blue Cross.  Wellstar Kennestone and non of her doctors would accept it.  She went with Kaiser this year and loves it.  The last I heard you could not buy Kaiser in Paulding, because, they do not have an office here.

 

I am retired from USAA.  They have always provided out insurance at a very nominal cost to me.  Under the new rules of Obamacare, they could not do that or the premiums would increase 285%. For 2016, we have to buy our supplement on the open market. They did put prices and coverage on their website.  I compared the prices on every one listed. A supplement F, with drug coverage was $180 per month for me and $180 for hubby, of course no co-payments and no deductibles.  I, also, compared all the HMO's and PPO's.  When you entered your doctors names, it would tell you if they took the insurance.  When I entered the medication in the medicine cabinet, it told me the co-payment for each medication. I ended up going with an Aetna PP0, which sounds like the one Lowrider has.  I hope I made the right decision.

 

If you are a USAA member, you can go on their website, look under heath insurance and compare what and who each covers and for what cost. 

Your plan sounds like a Medicare plan with a Medigap supplement. But, if you went through the marketplace, yours are individual policies. Your premiums are a bargain. My wife pays 759 this year; I cut back on her plan for 2016 and the premium will still be 685. I have heard good things about Aetna, and, in my opinion, a PPO (except in the case of Kaiser) is the only way to go.


Edited by ApolloBeachRetiree, 06 November 2015 - 03:05 PM.

Hillary was a terrible candidate. Plain and simple.

 

The Hildabeast IS a despicable CESSPOOL of CORRUPTION.


#22 lowrider

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Posted 06 November 2015 - 03:42 PM

In all honesty, I don't know how well my Aetna PPO will pay, as I haven't been to a doctor since turning 65 in September.

 

But I have gotten some prescriptions filled and they were the same or lower as my other plan.

 

And just to add, I'm fortunate in that AT&T retirees have an HRA, or a bucket of $2500 to get reimbursed for out of pocket expenses, including prescriptions.

 

I haven't submitted anything yet, so we'll see how complicated it is to get any money back.

 

I've been pleased with my PPO with BC/BS and Aetna.  They accept all of my doctors and my prescriptions.



#23 CitizenCain

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Posted 06 November 2015 - 04:16 PM

In all honesty, I don't know how well my Aetna PPO will pay, as I haven't been to a doctor since turning 65 in September.

 

But I have gotten some perscriptions filled and they were the same or lower as my other plan.

 

And just to add, I'm fortunate in that AT&T retirees have an HRA, or a bucket of $2500 to get reimbursed for out of pocket expenses, including perscriptions.

 

I haven't submitted anything yet, so we'll see how complicated it is to get any money back.

 

I've been pleased with my PPO with BC/BS and Aetna.  They accept all of my doctors and my perscriptions.

 

I just got off the phone with Aetna (ppo). It sounded great until I found out I would have to pay a deductible on prescriptions before a copayment ever kicked in around $200 a year. I then called Healthspring (hmo) no deductible but I would have to see my primary care Dr.- and sit in his office an hour to be seen - to get permission (once every 6 visits) before I could see the specialist I have been going to for the last five years.

Between the two = Damned if I do damned if I don't.   Decisions decisions.


Edited by CitizenCain, 06 November 2015 - 04:39 PM.

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#24 ApolloBeachRetiree

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Posted 06 November 2015 - 04:40 PM

In all honesty, I don't know how well my Aetna PPO will pay, as I haven't been to a doctor since turning 65 in September.

 

But I have gotten some prescriptions filled and they were the same or lower as my other plan.

 

And just to add, I'm fortunate in that AT&T retirees have an HRA, or a bucket of $2500 to get reimbursed for out of pocket expenses, including perscriptions.

 

I haven't submitted anything yet, so we'll see how complicated it is to get any money back.

 

I've been pleased with my PPO with BC/BS and Aetna.  They accept all of my doctors and my perscriptions.

IBM pays us an HRA as well but only if we enroll through One Exchange - sounds very similar to the process you have.


 

I just got off the phone with Aetna. It sounded great until I found out I would have to pay a deductible on prescriptions before a copayment ever kicked in around $200 a year. I then called Healthspring no deductible but I would have to see my primary care Dr.- and sit in his office an hour to be seen - to get permission (once every 6 visits) before I could see the specialist I have been going to for the last five years.

Between the two = Damned if I do damned if I don't.   Decisions decisions.

Healthspring - Sounds like an HMO plan. They tend to have lower premiums but they have limited networks and you have to go to your PCP first for everything.


Edited by ApolloBeachRetiree, 06 November 2015 - 04:40 PM.

Hillary was a terrible candidate. Plain and simple.

 

The Hildabeast IS a despicable CESSPOOL of CORRUPTION.


#25 jenilyn

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Posted 06 November 2015 - 05:14 PM

Exactly why you need to change your plan to a PPO in 2016.


We're definitely going to.
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#26 DallasRED

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Posted 06 November 2015 - 06:20 PM

Yes. And it's also a PPO. I would never subject myself to an HMO. LOL

I like to have control over my care.

I have a HMO...Basically that is what Prime is, I have no problem getting a referral if needed. They send it thru and it gets approved normally the same day. If I had issues, I could switch to Standard, but I would pay more out of pocket.


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#27 lowrider

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Posted 06 November 2015 - 06:31 PM

 

I just got off the phone with Aetna (ppo). It sounded great until I found out I would have to pay a deductible on prescriptions before a copayment ever kicked in around $200 a year. I then called Healthspring (hmo) no deductible but I would have to see my primary care Dr.- and sit in his office an hour to be seen - to get permission (once every 6 visits) before I could see the specialist I have been going to for the last five years.

Between the two = Damned if I do damned if I don't.   Decisions decisions.

 

 

Ever since Obamacare became effective, not only did my monthly premiums continue to go up, I had a deductible for prescriptions. A deductible for Prescriptions?  Never before until Obamacare.

 

Get used to it.

 

And good luck on your choice.  Personally I'm willing to pay to have control.


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#28 LPPT

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Posted 06 November 2015 - 06:55 PM

The most important thing I think for me is to figure out what will go to my deductible.

A plan where all my copay go to a deductible would be good. I am not sure if a plan does that. I know that there is a cap on yearly out of pocket.

 

I guess I will have to call when I am doing better and can follow better.

 As a side note I blew leaves for a few hours this afternoon. I may pay dearly tomorrow but it was good to be out of bed and outside for a while.

Some of the plans say 50.00 out of pocket then 20% after that. Does that mean I pay I pay 20% after that or they do?

For those that love Kaiser I will give you a heads up. The computer  is limiting what they can and can't do for patients now. What they allow Dr's to do for my Lyme is not even the standard for the CDC which is already putting us at risk for relapse and chronic Lyme. I have to leave or go alternative.


El Zorro

 

As far as releasing my name here, it's not going to happen.  There have been people here who found someone's given name and then found where they worked and made things difficult for them - all because they didn't like them here because of their political opinions.

 


#29 lowrider

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Posted 06 November 2015 - 07:37 PM

Laurie, co-pays do not go towards your deductible.  That's just something you pay at the time of a doctor visit.  On my BC/BS my co-pay was $20 for doctor visits.  This past year with Aetna, it was $5.00.  2016 will be $7.00.  And they were both PPO's.

 

Your deductible will get paid into each time you have a procedure.

 

An MRI, CT, Colonoscopy, Endoscopy. Etc.  Even a visit to the dermatologist and if he removes something that has to go to the lab, it goes toward your deductible.  

 

When I had to have a lot of things done for my hips, I would start in January and my co-pay would be paid usually with the first procedure.  Then you have the rest of the year to get things done and not have to worry about that $300 deductible.

 

If you find some plans you like and still have questions, give me a call.  We'll see if we can come up with something together.

 

And just to add, every PPO I've had pays in full for a yearly physical with my primary care, my routine pap smear and exam, and my mammogram.



#30 AustinPlantation

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Posted 06 November 2015 - 07:53 PM

I just had to switch from Piedmont Wellstar Medicare Advantage, because they are shutting down.

 

I  spoke with the same agent who handles several plans and we worked out which one was best for us.

 

Will be happy to provide contact info if you PM me.

 

 She went over all of our medical charges and the MD List my wife and I are using. She took all the tie I needed and we found a plan that handles all of our doctors and any more that we might need. No premium beyond Medicare. THought we'd wind up with an HMO, but this PPO is actually cheaper than the one we were going for originally.


Mel
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An optomist may not get there any faster, but he'll enjoy the trip more If you believe you can, you can --- and if you can't, at least you believed you could!

#31 confederaterose

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Posted 06 November 2015 - 08:17 PM

USAA is also going to provide us with a HRA.  $10,000 on 1-1-2016 and $200 per month until 2017 when the $200 per month goes up to I do remember what.

 

Since the maximum out of pocket for the Aetna PPO is only $4900, I am thinking even with worst case I will still be able to carry a good bit of money to 2017. They are also giving that amount to my Husband.

 

If our present health continues as is for 2016, I doubt we will have more than $600 for each to be reimbursed.

 

It really depends on each persons own health situation. Since I do not know what the future holds, it is just a roll of the dice.



#32 rockster

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Posted 06 November 2015 - 08:21 PM

Have you thought about a PPO?  That's what I've had for years and have kept all of my doctors in the Wellstar system.

 

First I was with BC/BS.  I had to change when I turned 65 because AT&T drops all of their folks at 65.   I'm now with Aetna,  another PPO and have kept all of my doctors.

OMG...................you are that old????? :diablo:



#33 lowrider

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Posted 06 November 2015 - 08:24 PM

OMG...................you are that old????? :diablo:



Time flies when you're having fun!!! Besides I never did look my age. LOL
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#34 AustinPlantation

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Posted 07 November 2015 - 07:47 PM

Wellstar started their own Medicare Advantage Plan, an HMO, 2 years ago along with Piedmont, but just cancelled it because they were losing a bunch. It was great for me as there was no premium above Medicare and low co-pays. So we just switched to the Aetna Medicare Advantage Plan for next year, a PPO and slightly cheaper than their HMO.

 

I had thought Wellstar was going to have their own HMO.


Mel
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An optomist may not get there any faster, but he'll enjoy the trip more If you believe you can, you can --- and if you can't, at least you believed you could!

#35 jenilyn

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Posted 07 November 2015 - 07:52 PM

Ever since Obamacare became effective, not only did my monthly premiums continue to go up, I had a deductible for prescriptions. A deductible for Prescriptions?  Never before until Obamacare.
 
Get used to it.
 
And good luck on your choice.  Personally I'm willing to pay to have control.


Our monthly premiums went up every year before Obama became president, and after. I don't know if that's because we are self employed or what.

We had Kaiser for several years and I absolutely loved them. It was so convenient. It eventually got too expensive and we had to switch.
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#36 Rocky's Mom

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Posted 07 November 2015 - 08:33 PM

Our monthly premiums went up every year before Obama became president, and after. I don't know if that's because we are self employed or what.
We had Kaiser for several years and I absolutely loved them. It was so convenient. It eventually got too expensive and we had to switch.


Our premiums have gone up every year before and after Obama as well and we have always had insurance through work. We have to pay a co pay for our prescriptions as well. It's $4.00 for the most part.
"There comes a time in your life, when you walk away from all the drama and people who create it. You surround yourself with people who make you laugh. Forget the bad, and focus on the good. Love the people who treat you right, pray for the ones who don't. Life is too short to be anything but happy. Falling down is a part of life, getting back up is living."

#37 lowrider

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Posted 07 November 2015 - 08:39 PM

A co-pay is not the same as a deductible. 



#38 Rocky's Mom

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Posted 07 November 2015 - 09:16 PM

A co-pay is not the same as a deductible.


Guess I don't pay attention to a $4.00 charge. It may very well be part of our deductible.
"There comes a time in your life, when you walk away from all the drama and people who create it. You surround yourself with people who make you laugh. Forget the bad, and focus on the good. Love the people who treat you right, pray for the ones who don't. Life is too short to be anything but happy. Falling down is a part of life, getting back up is living."

#39 rockster

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Posted 07 November 2015 - 10:19 PM

Obamacare stinks and is still such an unsettled issue. 


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#40 LPPT

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Posted 08 November 2015 - 07:01 AM

Our monthly premiums went up every year before Obama became president, and after. I don't know if that's because we are self employed or what.

We had Kaiser for several years and I absolutely loved them. It was so convenient. It eventually got too expensive and we had to switch.

Premiums went up because insurance companies have a lot more they are forced to pay for. Your physicals and mammograms may be free to you but they are not to your insurance company. A lot of the changes were about preventing medical bankruptcy. Many people were buying catastrophic policies, some knew that was what they were buying and others did not understand the terms well enough to understand just how little coverage they truly had.

My premiums have also gone up every year before the changes, I didn't get more coverage for the same money until the reform.

 

It drives me crazy to hear people call health care reform Obama care as though it were a type of insurance. I have seen many people say I want insurance but not Obama care.

 

I understand more about reform than I do actual policies having had Kaiser for probably 10 years, before that I was with a company that was self paid.

Problem with a company that is self pay is if you or a family have an extremely expensive medical condition they try to get you out of the company.

 

What we are doing is not going to work in the long term, because insurance is using the electronic record system to even further control your health care provider by tracking his procedures and diagnosis to find ways to withhold pay.

 

A doctor's goal is to make you better or manage your condition to help you feel better. An insurance companies goal is a to find a way to keep as much of the money you pay for premiums. You want your doctor paid for his service when he does a good job.

 

I am shopping for insurance that will pay my doctor well without robbing me blind. He is one of the most caring doctors I have ever met and the computer games are burning him out. He has to figure out how to get the computer to allow him to treat me the way he thinks I should be treated. One mistake one blank not filled in and he doesn't get paid. It is not just him it is all doctors now. My dad has to have every single treatment plan approved and not all get approved because the insurance company has already decided what treatments are allowed for his cancer. They could not care less whether he lives or dies, just what it cost.

 

The computer demands a diagnosis immediately, right or wrong this is a permanent record. Every doctor or specialist sees this and automatically believes that diagnosis the doctor had to put in to try a treatment he hopes works.

When others read it, they simply add their diagnosis on top of the previous, there is no removal of the prior diagnosis if it was wrong.

 

I found that a doctor had put in kidney disease as a diagnosis for a kidney infection. Did it get changed? no because the nurse putting in the info did not have the authority to change it.

Do you know how many medications or treatments I may not be allowed to get because of that.

 

If we all focused on paying our doctors and their support staff as well as possible the answers to our health care problems would solve themselves.

 

That is where I am at, trying to keep the best doctor I have ever had and making sure he gets paid every penny he deserves.


El Zorro

 

As far as releasing my name here, it's not going to happen.  There have been people here who found someone's given name and then found where they worked and made things difficult for them - all because they didn't like them here because of their political opinions.

 





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