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Medicare and Health Care


*This is a non-medical board. This site shall not be used to seek professional, medical or legal consultation.

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age person with End-Stage Renal Disease (ESRD). There are many different parts to Medicare; with all of these options, it can be confusing.

This forum will allow members to share their experience with medicare and seek advice* on certain medicare-related situations.

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sandhill  
#1 Posted : Tuesday, October 27, 2020 7:59:47 AM(UTC)
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I received information in the mail yesterday about a new Medicare Advantage plan specifically for APWU/Cigna high option members. I've had APWU for years (non-postal rates) and have been happy with the plan, so I kept it when I retired and added Medicare Part B. So far from what I am seeing, it looks like this new plan might offer additional benefits over standard Medicare, and it also provides a $50 monthly Part B premium subsidy.

One of the reasons I stayed with the high option APWU plan is due to the fact that my husband does not have Part B, so I didn't want to 'skinny down' our FEHB choice too much.

They're offering webinars that you can sign up for if interested in finding out more: https://www.uhcretiree.c..._OE_Meeting_Schedule.pdf

OUtside  
#2 Posted : Tuesday, October 27, 2020 9:22:33 AM(UTC)

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Interesting, one question would be, if the enrollment is self plus one but one doesn't have Part B, can that person be enrolled in Medicare Advantage? Off the top of the head, I would ask, why not in conjunction with fehb? But on the other hand, since Advantage fits into the Medicare situation in a certain way, why so? It's probably an easy answer, please let us know.
sandhill  
#3 Posted : Wednesday, October 28, 2020 5:18:59 AM(UTC)
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Originally Posted by: OUtside Go to Quoted Post
Interesting, one question would be, if the enrollment is self plus one but one doesn't have Part B, can that person be enrolled in Medicare Advantage? Off the top of the head, I would ask, why not in conjunction with fehb? But on the other hand, since Advantage fits into the Medicare situation in a certain way, why so? It's probably an easy answer, please let us know.


I watched one of the webinars yesterday. All in all, it sounds like the plan provides a number of extra benefits ($50 per month Medicare subsidy, $40 per quarter allowance on non-prescription items, Silver Sneakers, meals on discharge from hospital, etc.) I did ask the question regarding my situation and was told that if the spouse does not have Part B, they would remain on APWU high option.

I also asked about international coverage and was told it had the same benefits as in the US, but the you'd have to file forms after the fact for reimbursement. That is essentially how it works for us now with APWU high option.

The only 'downside' I'm seeing so far is that I'd be dealing with two different plans and two different companies for my husband and me (Cigna and United Healthcare) and different companies for prescriptions for each of us.

Now to pore through all the materials in order to make a fully informed decision ...

OUtside  
#4 Posted : Thursday, October 29, 2020 10:01:39 AM(UTC)

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I looked briefly at brochure and noted that subscribers in the Medicare Advantage enrollment must use providers who accept Medicare assignment. Those are providers in contrast to those who do not accept Medicare assignment and are then able to charge up to 115% of the Medicare rate for services. Most providers accept assignment but around I think it is 10% do not. I also think those who do not can, on a case by case basis, accept assignment, if they wish.

Page 141 of brochure covers retirees age 65+ who do not have Medicare, note it talks about providers who do not 'participate' with Medicare, this means providers who do not accept assignment but who nevertheless take Medicare retirees. You are probably familiar with the provisions on this page because your spouse does not have Part B. Perhaps a subscriber enrolling in the Medicare Advantage option who then goes to a provider who does not accept assignment becomes subject to the rules on this page for that provider's care. That would make sense ISTM but would be important to know when making the decision to enroll.
sandhill  
#5 Posted : Thursday, October 29, 2020 10:11:58 AM(UTC)
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Can you tell me where you found the brochure? All I've seen so far are summary documents that don't really go into the details of the new offering for 2021. I did contact them and all of my doctors are in network for the new plan, so that's a plus. The rep also said that even for out of network doctors, as long as they will submit billing to United Healthcare, that they will reimburse 100%.
OUtside  
#6 Posted : Thursday, October 29, 2020 10:47:47 AM(UTC)

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https://www.apwuhp.com/w...UHP_Federal_Brochure.pdf

Here is the quote from page 137:'Medicare will
be primary for all Medicare eligible services. Members must use providers who
accept Medicare's assignment.'

One of Checkbook's excellent tenets: 'Trust plan brochures.'

Edited by user Thursday, October 29, 2020 10:50:50 AM(UTC)  | Reason: Not specified

sandhill  
#7 Posted : Thursday, October 29, 2020 10:58:43 AM(UTC)
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Thanks for the link. So, all of our doctors accept Medicare, and I have frequently seen in the past on my husband's APWU summaries that payments for services have been limited to the Medicare amount even though he does not have Part B.

So far, I'm not seeing an overriding reason not to opt into the new plan for myself, especially since I can opt out at any point if need be. (And the chart on page 138 certainly shows the benefit for me to switch.)
OUtside  
#8 Posted : Thursday, October 29, 2020 1:46:52 PM(UTC)

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There are 3 types of providers with respect to Medicare, accepts assignment, does not accept assignment but accepts Medicare patients, and has opted out of Medicare.

Page 141 refers to 'participates' with Medicare referring to the first type (accepts assignment). The wording can be confusing, accepts Medicare, accepts Medicare assignment, accepts Medicare patients but not assignment, participates with Medicare. Since the vast majority of doctors accept assignment, some of the finer points may not always come up when discussing this subject.

For some reason, the option of Medicare Advantage requires using only the first type. If a subscriber uses the second type, it doesn't say on page 141 (that I saw) what happens, it's probably in the brochure somewhere, and would be good to know.

For most plans, if the subscriber uses a provider of the second type, the plan requires the subscriber to pay the additional 15% (or less if the provider bills less than the additional 15% permitted). So in those cases, the plan doesn't pay any of that 15%, but for some reason in this case, the plan is saying that is not allowed, subscriber must use providers who don't charge more than the Medicare rate (without the permitted overage).

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