Medicare Advantage Plan

I know Regular medicare covers Entyvio under Part B. Does anyone know if the united healthcare Medicare Advantage plan covers Entyvio

Thanks

Be very wary of leaving original Medicare for an Advantage plan! BTW, how did your safari trip turn out? / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)

Old Hat-The Safari was awesome thanks for asking. When I retired I received a stipend to help cover the supplemental plan. They are stopping that next year and offering a Hybrid Advantage Plan PPO plan instead that is not offered on the open market. I am going to check with the new insurance to make sure it still covers Entyvio like Part B does now.

If you have a lot of conditions it makes financial sense to stay with a supplement. No co-pays, no deductibles for multiple visits. And you can always get a stand-alone prescription plan. Savings cards can reduce prescription prices a lot too!
I was on an "advantage" plan that was discontinued, lucky for me, and was able to get into a supplement without paying more for my conditions. It's a bit per month, but I see multiple doctors for several chronic problems, so it comes out cheaper for me. It's also great for traveling as there are no costs for any doctor who takes Medicare.
Ignore the ads that pop up this time of year trying to snag you into "more coverage" which also have co-pays, and figure out for yourself which way to go. Don't look at just your current needs but what you are sure is going to come up.
There are several types of supplements, so consider carefully! The only difference between companies is the price - by law! So don't just look at a brand name.
If you drop your supplement you can't get back in at the same price. They will then consider pre-existing conditions, which they aren't allowed to do if you sign up at the beginning of Medicare.

I have another year before I go on Medicare. Since I will still be working, can I use my work insurance as the supplement or should I look for standalone supplemental insurance? This whole thing is kinda crazy and makes my head hurt lol.

I thought there was talk about abolishing the Advantage plans a few years ago because they weren't as good as they claimed and cost a lot of money for anyone who has health issues. I see that they are still around because I see the ads all the time.

I am so used to my work insurance that medicare is going to be a real learning experience that I have mixed emotions about. I have pretty good work insurance and after my 1st remicade infusion of the year I am maxed out for my out of pocket with insurance so after that everything is no charge to me the rest of the year -- doctor visits, labs, prescriptions etc ... I pay nothing except my premium.

CCinPA, check with HR about your private insurance coverage. I can tell you first hand, using your private insurance as a supplemental it pays very little, at least that was my experience & your deductible will apply.

When my husband turned 65 I had to find a supplemental policy for him. I got online & looked, each state has different coverages. You can look online now & sort of get an idea how it all works.

You can also look for an insurance broker that can help find coverage. Most do not charge for their service, I suspect they are paid a fee by the insurance company.

Advantage Plans are alive & thriving, lol. I will tell you what my dr told me about Advantage Plans, he said they are for healthy people that rarely need to see a dr. Obviously I did not fit that scenario.

The cheaper the plan, less coverage. You should apply for the assistance card to help with your deductible. Try not to stress, I know easier said than done.

damo123 said...
It is hard for us Europeans to fathom that these questions even have to be asked by patients in America. Our health systems differ, country by country, and probably the NHS in the UK is not the best but still provides a greater level of service and benefit that seems to be the case for americans. That said I'm not sure why the resultant premiums are then like.

But still....c'mon man!!!

If it weren’t for American ingenuity driven by free enterprise and competition, they’d be no Entyvio and precious few other drugs for UC or any other ailment for that matter.

America cures the world. Someone has to pay for that research. And that bill is paid by American Pharmaceutical companies.

America invents it and sells it to the world.

😊 on Humira

You keep believing that Island Time...all the major health breakthroughs are from europe....any major ones from america are funded from european researchers.

That the american health system is a joke is well known since ye guys spend so much time griping about it on here for the rest of us to have to hear. There is absolutely no evidence to support the statement that american cures the world...ye are barely top 10 in literacy, not even top 40 in math or science, not top 30 in life expectancy, not top 10 in infant mortality, ....in fact one of the few areas ye lead the world is defense spending. That is america's kinda thing!!

I remember watching Jimmy Kimmel Live during the January 6th events and somebody on his show said..."whatever will the rest of the world think of now"...to which jimmy replied..."i wouldn't worry about that, most of the rest of the world has been laughing at america for the last 10 years".

Leave the science to the countries who can do it properly.

Cc— the best supplemental plan used to be plan f as it completely pays the 20 % that Medicare doesn’t. But I believe they discontinued it (I’m grandfathered in so get to keep it). I believe the next best plan is plan g. The government sets the plans so it doesn’t matter which company you go with (although some of them add in incentives like silver sneakers gym membership which give you free access to participating gyms). The government also pays a stipend to licensed insurance agents so it’s free to you to talk to one. I’d find one who specializes in Medicare as they understand the plans better.

Medicare with a supplement F works great for me because I pay $0 for my entyvio infusions. Since they are administered by a dr/hospital setting, they are covered under the medical side. Also hospitalizations are covered completely if you have the plan f. I’m not sure about the others.

The really difficult part of Medicare is the part D which is the prescription side. Different plans cover different drugs at different rates and most of our UC drugs are highly expensive. That should get better when the new rules go into effect getting rid of the “donut hole” and give us a yearly cap on out of pocket.

Oh also there’s no dental plan. I believe the advantage plans have some but I would not choose an advantage plan. They try to make them sound great in all the ads but my understanding is they’re basically HMOs and end up costing more in the long run if you have a chronic condition.

I honestly think our medical is pretty darn good. It’s the prescription and drug companies that are out of control seeking profit over health.

RE: "Leaving the science to countries that can do it properly" comment above: the 1st polio vaccine was devised by American Dr. Jonas Salk at the University of Pittsburgh Medical Center in Pennsylvania, USA, in 1954. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)

Re: "Advantage Plans are basically HMOs."

Like everything, it's get what you pay for. I choose an Advantage Plan that is a PFFS, which means it covers even Drs which wouldn't ordinarily accept Medicare... no provider is wholly "out of network".

Too darn many choices, in my opinion. We all end up picking what looks best when we reach our personal level of exasperation! Not scientific at all.

I do have multiple chronic conditions, disabled by Social Security at 42, and have been happy with the Advantage plan I've had for over 20 years. Sometimes new medications are tricky, but there are ways around it... I hate to use Canadian mail-order pharmacies but they work for my otherwise exorbitant meds.

Post Edited (Lynnwood) : 10/19/2022 9:37:21 PM (GMT-7)

Lots of good info in this thread for us old folks in the U.S. Thanks, everyone!! Shame this has to be so complicated. The older we get the harder it will be to navigate all of this. I hope I can pick a good plan/plans that I will be able to stay with.

I did a little poking around on Medicare's website and there are so many plans! Does everyone get A & B from medicare and then we have to choose the other supplements? D is for drugs I think and then there are a bunch of others. This can't possibly be what was intended for Medicare. What a mess!

I was looking at some prices and Plan G had prices ranging from about $100 to over $300. If each plan has to cover the same things why the price range?

CCinPA-- once you enroll in original Medicare, their HQ sends an update to insurees every autumn that explains new features or changes to be implemented in the following year. If you choose an AARP-authorized Supplement Plan (Medigap policy) from United Health Care Insurance Co., you'll be obliged to join AARP, too, at $16 annual membership fee. However, AARP then will send you their monthly magazine plus frequent bulletins with lots of info on health, govt. legislation/practices, money management for seniors, etc. Not a bad set-up because AARP lobbies Congress for action on senior issues, and gets more attention there than most individuals would. *** The doctor who DXed my UC decades back advised me to always stay in a large medical insurance pool-- because they may change fees or regulations over time, but are less likely to majorly fail their enrollees in the long run. I have found that advice very helpful in my retirement planning. Best wishes-- try to stay calm, organize info, think positively, and you'll figure out what is most beneficial for you to choose. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)