I have to choose a new plan

[question everything]

My current carrier offers several plans and I need to ask what is the difference. Different cost - for what?

But I stared checking the list of provider and could not find my GP.

Then I remember that I had a letter from the Chief Medical Officer of that network telling me that they've contracted with two other insurers.

I really do not want to change doctors. For one, that clinic is only 3 miles away from my house.

Thus, I either have to change insurer or continue to use my doctor as out of network where I will have to pay 40%.

Prescriptions deductible are $300 with my current insurer; $415 if I switch to a Blue.

My total prescription this year has been around $300, about half was for EpiPen. And $47 for the new Shingle vaccine.

And then there is a letter from Medicare that offers "Option 3 - change to Original Medicare and add Part D. I have no idea what this is about and, of course, whether my doctors will accept this.

I really need to start making calls. What bugs me is confusing seniors with these details.

And, yes, I prefer to stay with a non-profit insurer (in theory) one that is not listed on the stock exchange.

[yellowdogintexas]

1. Original Medicare does not have networks so your MD might take Medicare

Part D is your Prescription Drug coverage if you have original Medicare.
And there are a ton if different plans with different formularies. I need to do mine over this year to make sure I don't need to change myself.

I spent 40 years working in medical insurance and I still get a little crazy dealing with my own coverage

[Hoyt]

2. Original Medicare is an option, but you'll end up paying more in premiums

if you get a Medigap and drug policy (Part D).

You could ask your doc to look at participating in your Plan, or accepting their allowable.

It’s tough assessing the different Medicare Advantage plans and traditional Medicare, especially if you want to keep a certain doctor. At our age, I think it’s a mistake to think current good health will continue. But who knows? It’s a crapshoot.

[question everything]

3. My doc is part of a vast network of clinics and hospitals

and cannot make this choice alone.

I thought that I did not need to worry about it but now all of a sudden have to dig.

[Hoyt]

4. I know. Been through that. Good luck.

[JayhawkSD]

5. Medicare offers a plan finder.

You can use this planner to find a drug plan and health plan. You enter a list of medications you take and your choice of local pharmacy and it presents costs for different drug plans and health care plans. I found it to be easy to use, and it offered very detailed options on 30 drug plans and 30 health plans.

[question everything]

6. Thanks, I will

[JayhawkSD]

7. profit vs. nonprofit insurer.

"I prefer to stay with a non-profit insurer (in theory) one that is not listed on the stock exchange."

I would suggest you abandon that criteria. Choose your insurer based on the cost and benefit. Whether it is profit or not does not affect your pocketbook when your health is at stake. There are better ways to make social statements.

What people do not look at in the health care cost is that health insurance companies operate at a very reasonable profit margin - mostly in the 5% to 11% range. Health care providers are an entirely different story. They are the true ripoff artists, operating at obscene profit levels. Hospitals almost always run in the 50% to 60% profit margin area. Doctor groups are close, mostly making 50% profit. Laboratories (testing) typically run a profit margin of 40% or more. Drug companies make profits in the range of 35% to as much as 50% and up.

Inflated provider costs are paid by health insurance companies, who then must increase their premiums so that they can make a profit, usually less than 10% or so, for their stockholders.

Health insurance is not the cost problem in health care cost. Providers are.

[question everything]

8. United Health - the one pushed by AARP - has once paid $100 million, yes million

in compensation to its CEO. I think that by now it is "only" $27 million.

When you are a public company - any company - your first obligation is to your shareholders. And one way to do this is to cut costs, meaning not paying for costly procedures.

On the other hand, a friend of mine, whose birthday is in June and who, when joined Medicare more than five years ago was taking many brand name drugs, though that he would have to purchase a more expensive one that would cover him while in the "donut hole." The agent told him: it is already May. You probably will not reach the donut hole before the end of the year, or is you do - it won't be much. Get the cheaper one and by next year you will see. And he did. This is an insurance company that I choose and have, until this year.

[question everything]

9. So I did. Will have all my providers

a slightly more expensive but no deductions for medications which, I think, will come to the same thing. Also less co pay.

As I do with all decisions in my life, spreadsheet to the rescue.

I tallied all my prescription purchased over the year, and the amount that I will be charged with each purchase and I think will come to the same $300 or so.

This is a respected carrier with high marks from Medicare.

Will give it a try this year.

Sigh