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Comparing health plans. (Medicare or otherwise.)

Advice and reference info from members.  (Updated Mar 21, 2022.)  Comments: info@hpalumni.org 

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

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 than similar standard 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 members of a particular insurer." --2022 HPInc Enrollment Guide

- Some members have found that HP or HPE group plans provide better coverage for their specific situation than individual plans -- for example, coverage of dependents, pre-existing conditions, or medications.

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

- With Medicare plans, even though there are government specifications for open-market Advantage and Supplemental plans, employer plans do not have to match those specifications.

From our discussions on the HPAA Benefits Group, 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."

"Dont throw out the baby with the bath water. HPs 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 individual 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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