Medicare Advantage

[Patty Hann]

+2, from about six years before retirement, so the transition was seamless, to the point of being unnoticeable.

(I'm a big fan of vertical integration when it comes to medical stuff. None of the 'out-of-network' hassles, no driving over to some lab on the other side of town to get blood drawn, then yet another location for physical therapy etc. I've got primary doctor, lab, x-ray, P/T, optical, pharmacy, all in the same building about 2 miles from the house.)

"Jack-of-all-trades-Master-of-none"
My experience of "all under one roof" has invariably been that some specialties do what they do really well, and other ones don't.
Optical might be really good but PT is sub par.
I've also had the experience with blood draws that yielded wildly inaccurate results'; bad enough that I stopped going to that particular lab.
No other labs ever had that problem with my "draws"...pretty consistent results.
Not saying I like driving hither and yon for medical stuff, but I'll do it if that's what it takes to get quality care.
Fortunately I don't have to do it too often, typically annually.

[Mike Henderson]

Dave,

A neighbor across the street came over a couple months ago to ask advice about hearing aids. He had been using his string trimmer (electric) when he said the hearing in one ear diminished dramatically. I have both a cochlear implant on one side and a HA on the other. I asked him "Didn't you serve in Vietnam?" He said yes. I told him why don't you see if the VA will cover you. After he left, I immediately went online to confirm my suspicions. I was right. Those who served in country in Vietnam are covered. Those like me who served during the period ('68-76 in my case) but never served in Vietnam aren't covered. He called the VA, got all of his prescriptions tranferred to the VA, they assigned him a new primary care nurse practitioner and he has scheduled a hearing test. He came over a couple weeks ago to thank me for the information as it was saving him money.

I'm not absolutely sure about this, but I think you have to have a certain level of disability to get completely free hearing aids from the VA, even if you served in Vietnam.

I get my hearing aids free from the VA, but I think my level of disability is high enough. If you were 20% disabled, for example, you probably could get your hearing aids from the VA but you would have to pay a co-pay.

Those of us who served in Vietnam have an "advantage" because it is assumed we were exposed to Agent Orange and that opens up coverage for certain medical issues (such as Type II diabetes).

I've been getting my hearing aids from the VA, but using Medicare for everything else. I'm going to see if I can start getting my prescriptions from the VA. My experience with the VA has been very positive.

Mike

[Patty Hann]

I wonder, based on our experiences if we would support Universal Healthcare here in America? Brian

Look at Britain... their Health care system is in a crisis mode.

https://www.cnn.com/2023/02/06/busin...-uk/index.html

I wouldn't want modeled on Canada's system either https://www.caringsupport.com/blog/a...lthcare-system

Nor Europe's https://www.marshmclennan.com/insigh...ms-europe.html

What a lot people -- who like the idea of Universal Health care and point to the UK and Europe as "shining examples"-- don't know is that in both the UK and Europe the people who can afford to buy private insurance do buy it.
They buy it to avoid the problems mentioned in the articles, in particular long wait times, not getting the same Doctor if you use a clinic (UK).
I'm not certain but I don't think you can buy private health insurance in Canada.
What I do know is that there are winter visitors (here in AZ, we get a lot) from Canada will schedule medical procedures here and pay cash rather than endure the long wait times there.

There is no free lunch... you never get something for nothing.

I like being able to choose my doctors and specialists.**
I like being able to keep the same doctors and specialists.

I like that wait times for procedures are measured (at worst ) in a few months (and sometimes in only weeks) and not in 6+ months to two years (or more) .

** When I had my lumbar fusion done (L5-S1, w/ bilateral instrumentation) I got one of the very best neuro-surgeons in the state to do it; no complications, and a smooth recovery.
3-1/2 years later (my 60th B-day) I did solo Rim-to-Rim hike (N to S) of the Grand Canyon. Tiring, but the back gave me no problems at all. It still doesn't.
(But it's hard on the knees going down, very hard.. 4200ft drop over 6.5 miles; i.e., a little more than a 12% grade on average. It's steeper at initial descent, less so the farther down you go )

[Lee DeRaud]

"Jack-of-all-trades-Master-of-none"
My experience of "all under one roof" has invariably been that some specialties do what they do really well, and other ones don't.
...
I've also had the experience with blood draws that yielded wildly inaccurate results'; bad enough that I stopped going to that particular lab.
No other labs ever had that problem with my "draws"...pretty consistent results.

I'm just not sure how having standalone specialists helps that problem, given that I've had similar experiences with traditional insurance. The problem was that sometimes "that particular" whatever was the only only one that was in-network without driving stupid distances. Or having them decide after the fact that, no, they actually aren't in-network for your particular combination of doctor/insurance.

The thing about Kaiser, at least here in SoCal, is that it's BIG. If a particular specialist is sub-par at a given location, there are others available, perhaps at some loss in convenience.

[Patty Hann]

I'm just not sure how having standalone specialists helps that problem, given that I've had similar experiences with traditional insurance. The problem was that sometimes "that particular" whatever was the only only one that was in-network without driving stupid distances. Or having them decide after the fact that, no, they actually aren't in-network for your particular combination of doctor/insurance.

The thing about Kaiser, at least here in SoCal, is that it's BIG. If a particular specialist is sub-par at a given location, there are others available, perhaps at some loss in convenience.

Kaiser was always big, and highly rated.
Unfortunately it does not operate in AZ.
And vertical integration is great, if it works, which it does for you.
I've just resigned myself to having to drive to various sites for different services.
But what I was saying (apparently not very well) is that there always seems to be at least one "specialized service" (of the Under One Roof group) that I 'm not happy with, and so have to drive anyway, at least for that service.
And with Trad Medicare, almost all doctors are "in network".

[roger wiegand]

For those who think the insurance companies are their friends, I'd just note that the US spends about twice as much per person as the other "wealthy industrialized countries" (about 20 countries in that group), and achieves the worst performance in terms of basic public health measures of any country in that group; e.g. the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, and the highest maternal and infant mortality.

[Dave Fritz]

Well said Roger, facts are facts. Look to Washington to see why this is the case.

[Ronald Blue]

I didn't read everyone's replies because everyone's location impacts the options available. Whichever version you choose I recommend you look at all the options. If you haven't established an online Medicare account you need to. Go there and it will show every option available to you in your location. In Illinois at least it can vary by which county you live in. So just because friend John Doe that lives an hour away has something available doesn't mean you will. On the Medicare website you can compare maximum out of pocket and prescription drug costs. There also are actual agents that will help you find what fits your needs honestly. I went with Medicare Advantage and thus far have been pleased with it. My agent advises to review the options every year because they can change. Standard Medicare might be the best option for you but until you compare you don't know. My particular plan gives $166 quarterly for OTCHS shopping. My medications cost me zero at this time. Educate yourself to what's available. You can also see if your Dr is "in network" by searching providers. I also have a $1500 Flex card to pay for medical services not covered.

[Dave Fritz]

Excellent advice Ronald. I volunteered for several years for the Aging and Disability Agency in our county helping folks select their best Medigap policy. Medicare has a fantastic website and clearly points out the various options available.

[Jim Becker]

I wonder, based on our experiences if we would support Universal Healthcare here in America? Brian

That's difficult to discuss without getting political and we can't do that here, but it doesn't take a rocket scientist to see that it might be a lot simpler. One of the biggest challenges with how things are currently done is that it's uber-complicated for both the patient and the provider. This thread is a good indicator about how complicated it is simply because there are so many choices and decisions that have to be made just to have coverage. And not having coverage is kinda a big problem. I hope as a society we can work this out for sure, but it may not be within some of our lifetimes.

Something that has to be clear based on other comments already recorded, however, is that Universal Healthcare is not "free". It's payed for in a different way that we currently experience for the most part here in the US. And that, unfortunately, is where the discussion would get political and we're not going there.

[Jim Becker]

"Jack-of-all-trades-Master-of-none"
My experience of "all under one roof" has invariably been that some specialties do what they do really well, and other ones don't.

I don't believe that's what Lee was referring to with his comments about the provider network he's in. There is great advantage in continuity of care when primary care as well as many of the specialties come from a related umbrella organization because it is easier to navigate. I'm doing the same here by staying within the same local provider network (I'm not required to as my plan is a PPO) which while being a smaller setup than what Lee is part of, is very comprehensive. Some of the specialties are directly associated with larger, world-class groups. An example is the ortho surgeon I'm soon seeing for my right wrist...he's part of the local hospital care network that I get most services from, but is also associated with Rothman which is a very large, well known orthopaedic organization in Philadelphia. Things like optcal are not normally part of the regular health insurance situation unless surgery is involved. (I have experience there, too)

[Bill Dufour]

One thing that national health care does is reduce the costs of all the insurance people. My doctor has 10% or more of his staff who just figure out how to bill the insurance companies. That is all they do all day long. I assume the insurance company has a similar number of employes on their end answering the staffs questions.
I remember decades ago reading about one insurance company who dropped the requirement for a second opinion before authorizing expensive procedures. they figured out most times the second opinion said go ahead and do the procedure. They calculated slightly more procedures would be paid for but 100% of the cost of second opinion doctor visits and more tests would disappear. They did this and found they saved money by dropping required second opinions..
Bill D

[Stan Calow]

This is a great book on the subject and clears up a lot of the misinformation out there: "The Healing of America" by T.R. Reid. Heck, I may have first seen it recommended here on SMC some time ago.

[James Cheever]

Another option for any retired military (active or reserve retired) is Tricare for Life (TFL).

With TFL, all you need to have is Medicare Part A and B coverage. Nothing else is needed and there's no Rx doughnut hole. There could be a cost impact for the Part B coverage, depending on your retirement earnings.

As an example, I have two advanced cancers (stage 3 melanoma and stage 4 colon) and have been on chemo for many years now. With TFL, there have been no copays or deductibles and all my meds are fully covered.

Your situation may vary (and cost could be a factor), but you should at least give TFL a look to see if would work for you.

[Mike Henderson]

Just FYI, TriCare does not cover hearing aids. You need a disability rating to get free hearing aids.

If you're retired military, you almost certainly have TriCare.

Mike