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1. Medicare Decoder    2. Basics    3. Advantage vs. Original    4. Compare Plans    5. Via HP or HPE    6. Trouble; Contacts

Comparing health plans. (Medicare or otherwise.)

Advice and reference info from members of the independent HP Alumni Association.  (Updated Nov 7, 2022.)  Comments: info@hpalumni.org 

Join the HPAA's Benefits Forum Covers topics such as COBRA and retiree health benefits, annual enrollment, and transition to Medicare.

"Coverage and costs vary widely among both Medicare Advantage plans and Part D prescription drug plans. From one year to the next, plans can change their premiums, cost-sharing requirements, and scope of covered drugs and supplemental benefits, as well as provider networks or prior authorization requirements. These changes could lead to unexpected and avoidable costs, and disruptions in care for beneficiaries who stay put and do not at least review their options annually..."

"...Medicareís official information resources are not widely used... Just under half of beneficiaries reported that they had read all or part of the Medicare & You handbook, and 44 percent said that they (or someone on their behalf) had visited the Medicare.gov website. "

--from KFF, the nonprofit healthcare research foundation endowed by heirs of industrialist Henry J. Kaiser. (No connection with Kaiser Permanente. Often criticizes Kaiser's current practices as not being in line with the founder's intentions.)

Heads up! When considering health plans, compare the details.

Health plans provided through employers to retirees and current employees are "group" plans that have been customized for the specific employer.

- Group plans Can be much more expensive -- but may have better features -- than similar individual plans purchased on the highly-competitive open market.

- For group plans, "Premiums reflect the underlying cost of care across the HP [or HPE] retiree population."  Why HP group plan costs are going up. hpalumni.org/health-cost

- For open-market plans, "Premiums are based on the competitive market. They reflect the underlying cost of care across all the customers of a particular insurer." --2022 HPInc Enrollment Guide

- A group plan may be better for your specific situation -- dependents, pre-existing conditions, or medications. While there are government specifications for open-market Medicare Advantage and Supplemental plans, employer plans do not have to match those specifications.

- Group plans and open-market plans with similar names from the same carrier may have very different coverage features.

From our discussions on the HPAA Benefits Forum, of the many factors involved in selecting a health plan, there are several key issues:

- Whether the plan has an annual out-of-pocket maximum or a lifetime cap. You could get wiped out financially by a major health issue.

- If you have pre-existing conditions.

- What medications you currently take. Can make a huge difference in your cost via co-pays.

- Other co-pays. For example, the co-pay for hospital stays can vary from zero to hundreds per day.

- Whether your current doctors -- and the hospitals and specialists they use (such as anesthesiologists) -- accept each plan. ("In-network" vs. "out-of-network.")

- How coverage works if you are traveling, if you spend time at a child's home, or if you have two homes.

- Dependent coverage.

Member comments:

"For Part D plans, do your research on Medicare -- https://www.medicare.gov/plan-compare/ -- and on the web sites of the plans that interest you. Always generate a drug cost for the pharmacy that you prefer to use. Take Aon's drug costs with a grain of salt. If they happen to agree with Medicare and the plan, then trust them. Otherwise, ignore them."

"If you run the numbers early in the enrollment period, consider rerunning them later, because things can change. Check the out of pocket and deductibles. In CA the HP Kaiser group plan has much lower amounts for the same cost as the Kaiser individual plan."

"Donít throw out the baby with the bath water. HPís Humana Gold Advantage program in Colorado is great and no additional charge."

"I'm insuring my college age son. He's on UHC PPO 650 which is a much better insurance than what is available with 'Affordable' Health Care insurance. Once he graduates and is on his own, I'll go to either AARP/UHC, Aon/UHC or the open market. The HP group insurance isn't competitive for those on Medicare but again, in my case I have to insure a dependent who is not of Medicare age."

"Just make sure you are comparing apples to apples."

Comparing open-market plans on the official Medicare site...
- Advantage plans. Find plans in your state. Compare benefits.
- Medigap plans.  Find plans in your area. Compare costs, extra benefits, drug coverage, and ratings.  
https://www.medicare.gov/find-a-plan/  (You can select "Continue without logging in.")

Medicare next step: 5. Medicare - HP or HPE  If receiving benefits from HP or HPE

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