Wednesday, July 28, 2010

US Medicare plans

When Nortel made its recent attempt to terminate the medical plan for retirees it made some agreement with United Healthcare who sent out materials with their plans for retirees.

The one I received in Georgia was for a Medicare Advantage plan that was an HMO. It looked pretty good since there was no added premium and I could go to my primary doctor for a copay of $15 and my specialists for for a $40 copay. It even had an optional dental and vision rider that I could purchase.

Everything looked good until I checked with my primary care doctor and found that his practise did not accept this insurance. All my specialists were listed in the database but not him. It seems that this is quite common with many HMOs and it is really unfortunate since the primary care doctor is the one most seen by people. Maybe the copay is just too low. I checked on the United healthcare site and found that my doctor was in many of the other insurance plans they offer but not this one.

So I called the billing department of my doctor's office and they were very patient but explained to me that they just did not want to be involved in that type of insurance. They told me that however they did accept Medicare Advantage PFFS plans and perhaps I should look into that. (PFFS is Private Fee For Service)

So I looked at the booklet Medicare had sent out to me at the beginning of the year to see what Medicare advantage plans they offer. If you don't have the booklet you can look up the plans at the Medicare website. There are many different plans offered by a number of insurance companies including the same one that United Healthcare had sent out to us. There are also Medigap plans which are supplementary plans to basic Medicare which you can find by looking at the various insurance company sites. In my case I am more interested in the advantage plans so those are the ones I concentrated on.

Each plan is specific not only for the state you live in but also the county within that state. I found out that in Fulton County, Georgia, where I live, the United Healthcare HMO plan is the only one they offer. However there are other companies like Blue Cross Blue Shield, Cigna, and Humana who offer Medicare Advantage plans in my county.

I found that Humana offers a PFFS plan in Fulton which may meet my needs but I will have to pay a premium for it. I am checking up on these things because I know that Nortel will eventually pull the plug and I don't want to be stuck and scrambling around when they do. I also want to continue going to the same primary care doctor since he knows me well, understands my heath history and has all my records.

So I advise everyone to check out what is available now in your own county so that you can be prepared when Nortel finally removes our medical benefit.

1 comment:

  1. Since this is a Medicare Plan my assumption is that you are over the age of 65 and therefore covered by Medicare and your plan is only supplemental in nature.

    I on the other hand, just turned 62 and needed complete medical coverage for my wife and I until we reached the ripe old age of 65 and qualified for Medicare. United Health Care's premium for the same coverage that I have with CIGNA ( retiree medical plan ) was going to cost an $800 additional each month.

    Did not seem like a good deal to me.