What is the difference

What is the difference
I was convinced a few years ago, that I needed a Medicare supplement. Went with Humana. I live in a rural area. The largest town in the county is about 12-15 thousand. No problem with the local clinic but when I went to my dermatologist in the Metroplex, they would not take my Humana card. I asked about Medicare and they informed me that Humana controlled my Medicare and they couldn?t take either. They told me if I only had regular Medicare they could take that. The same year I went to another specialist, out of my county and was told the same thing. I ask if they took cash and of course they did. Their rates were posted: office call $60, My procedure $380. When I started to pay, the entire charge was $180. $260 lessor 1/3 of the posted rate. I went through a similar experience with the prescription drug program and dropped it. My wife was recently given a prescription which cost $265 at Walmart. I called an independent pharmacist and was quoted a price of $39. I had the prescription transferred and when I went to pay they told me due to the fact that I didn?t have insurance it would cost $21. I think we have 2 problems with health care. 1. Insurance companies 2. Government

I will offer that there is a third problem and that is the people processing the claims and other paperwork. All too frequently the office staff knows how to work it, but not how it works. I've encountered a number of cases where it made no sense to me and when I asked a friend who works with such claims, she explained how to approach the issue and was always right. It's certainly a Gordian Knot.

I get all of my medications through the VA except one. That was because I needed help for sciatic pain last year and the VA was giving me the run around and set me up with a therapy clinic over 200 miles away. Since I carry supplemental insurance along with medicare, I opted to go locally. When I went to pick up my prescription at local drug store they asked if I had drug insurance. No. Charge was $11. Next month getting a refill they wanted like 28 so I said, well, I got it for $11 last month. OH, well, we will refigure it, ok $11. Next time, same thing so now I write $11 in big black letters on the bottle when I take it in. Then, no problem. Something is messed up. A lot of my drugs from VA actually cost me more, $8 than without insurance at local drug, but then one is expensive so I stay with the VA.

You DO NOT have a medicate supplement, you have an "advantage plan." Huge difference, as you have found out.

I considered an advantage plan for about 30 seconds then went with regular Medicare and BC/BS supplement, Plan 65, plan F (which pays all deductibles).

You can switch back next year. If you want to switch before that call Medicare and ask what it takes.

1948Case has hit the nail on the head. You will need to get out of your Medicare Advantage plan and switch back to Original Medicare. Then you can buy Plan F as your Medicare supplement which will pay all deductibles and co-pays that Medicare doesn't. I have Original Medicare and Blue Cross/Blue Shield plan F that covers both me and my wife and the two insurances, so far, have paid for everything. Surgeries included. However, our insurance premiums are almost $9,000 a year. At our ages, that's probably a bargain.

(quoted from post at 19:07:40 06/29/17) 1948Case has hit the nail on the head. You will need to get out of your Medicare Advantage plan and switch back to Original Medicare. Then you can buy Plan F as your Medicare supplement which will pay all deductibles and co-pays that Medicare doesn't. I have Original Medicare and Blue Cross/Blue Shield plan F that covers both me and my wife and the two insurances, so far, have paid for everything. Surgeries included. However, our insurance premiums are almost $9,000 a year. At our ages, that's probably a bargain.

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You paid $9000 a year and he paid $180.
Why in heck would he want to change?

Actually, I paid another 1400 last year because I had to have a pacemaker but, I am still at least $50,000 ahead. Insurance is a huge racket. I don't have Insurance on my vehicles except liability. No house insurance. I drive carefully. Have all electrical wiring in my house in conduit and concrete shingles on my roof. I may run out of luck tomorrow but I have saved thousands. I am opposed to paying insurance to protect the carless,bodyshops, the roofers and the insurance companies.I am also opposed to paying taxes to pay for people who don't take responsiblity for their qwn actions.

It's decent of the providers to give you their "insurance pay" rate on meds and procedures. You don't really have a supplement if Humana "controls" all your health care. There's a different word for it that escapes me right now but my mother had one once. You might wish to contact Humana and see if they have "network providers" that are in your area the will accept their payments. Otherwise, cancel them and get a different program.

(quoted from post at 18:14:16 06/29/17)

(quoted from post at 19:07:40 06/29/17) 1948Case has hit the nail on the head. You will need to get out of your Medicare Advantage plan and switch back to Original Medicare. Then you can buy Plan F as your Medicare supplement which will pay all deductibles and co-pays that Medicare doesn't. I have Original Medicare and Blue Cross/Blue Shield plan F that covers both me and my wife and the two insurances, so far, have paid for everything. Surgeries included. However, our insurance premiums are almost $9,000 a year. At our ages, that's probably a bargain.

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You paid $9000 a year and he paid $180.
Why in heck would he want to change?

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$180? That was one procedure. Was that all he had all year?

Is the Advantage plan free? No premiums? I doubt it. My annual premium is $6,300 for Medicare/BC/BS including prescription drug coverage. $99 each for medicare, $137 each for supplementary, and $25 each for drug coverage. We pay no copays and have no problem with getting doctors to take it except for my wife's podiatrist. We do pay $4 to $15 per prescription but my wife has had brain cancer and takes a lot of medicines.

My dad had the Humana thing and it cost him and my mom dearly. A real racket. They were constantly fighting for coverage and we've never even had to ask.

(quoted from post at 18:54:41 06/29/17) Actually, I paid another 1400 last year because I had to have a pacemaker but, I am still at least $50,000 ahead. Insurance is a huge racket. I don't have Insurance on my vehicles except liability. No house insurance. I drive carefully. Have all electrical wiring in my house in conduit and concrete shingles on my roof. I may run out of luck tomorrow but I have saved thousands. I am opposed to paying insurance to protect the carless,bodyshops, the roofers and the insurance companies.I am also opposed to paying taxes to pay for people who don't take responsiblity for their qwn actions.

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Are there no premiums for Humana or Medicare?

If you don't mind me asking, what did the out of VA Dr. do for your sciatic pain? Did he get rid of it for you or is he controlling it with meds? I have sciatic pain also and haven't gotten much relief from VA.

My oldest daughter is a registered nurse working in the oncology department at a local medical center. She says Humana is the ABSOLUTE WORST company to get reimbursement from. The medical center will no longer accept it

Agreed, if we could get the government out of health care and get competition going prices would be more reasonable.

Wow! Talk about living on the edge.

As I understand it, the Medicare Advantage plans are the same as the HMOs everyone loves so much, longer wait times, can only go to certain Dr.s and must be referred if going to anyone other than your primary care, which sounds like what Pat has. In it Humana or whoever you select is the controlling party.

With a supplement plan (PPO type), You pick any Dr. so long as they accept it. Medicare is the controlling party, and the supplement plan kicks in at the end of Medicare's pay. In my case it is Humana, and I picked a plan that has no copay or deductible for the medical. It is more expensive, but due to my back pain and pain medicine I have to go to Dr. monthly, so it is worth it.