# Do I need a plan?



## jeb (Nov 14, 2016)

I presently have a Humana advantage Regional PPO plan - but also have VA benefits.

In the last 2+ years I have had the Humana plan I have only used it one  time - to set up with a local DR. - everything else has been through the  VA.

Before moving to NC I lived in FL and had a great advantage plan there  but the insurance commission in NC has limited me to few options in NC.

1- Since I have VA benefits, do really need an advantage plan?  
2- I assume that some amount is taken out of my SS to pay for the  advantage play,  If I drop it, do I get that amount put back into my SS?
3- Is there any way to find this amount?

Also, I have drugs through the VA and in FL I received an amount back into my SS each month - in NC, like most Republican controlled states, I do not.  Also, in NC there are very limited options for any type insurance.

Appreciate the help - jeb


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## RustyatMMC (Nov 14, 2016)

Hey Jeb,
Here is some info for you. A late "welcome to NC" to you!

1- Since I have VA benefits, do really need an advantage plan? - Depends on what you want. If you live near a VA facility, you might not need a Medicare Advantage (MA) plan. Some people live several hours away from a VA facility and it is more convenient to go to a local doctor for a quick visit. Others don't like the VA drs and choose to use someone local. It all depends on what you want.

2- I assume that some amount is taken out of my SS to pay for the advantage play, If I drop it, do I get that amount put back into my SS? - Yes, if you pay a premium with your MA plan, if you cancel it, you get it back in your social security starting the month after your plan ends.

3- Is there any way to find this amount?
Here is a link to the NC Dept of Ins page on the different med adv plans (medicare part c). 

http://www.ncdoi.com/SHIIP/Medicare_Advantage-Medicare_Health_Plans_(Part_C).aspx - make sure you are looking at 2017. Each county will have what's available and what the premium will be for that particular year. More rural counties have fewer options, more urban counties have more options to choose from.

It doesn't have much to do with Republican controlled states in this case. It's more to deal with reimbursement rates the feds give the medicare advantage (MA) companies. When you assign your Part A and Part B to the MA insurance company, they also get reimbursements from the Feds. Depending on where you are in the country, the rates are different. In FL, I am sure the rates are better than what we have in NC. In metro areas, the reimbursements are higher than what's available in rural areas. That's why we have so few options in rural areas of the state. The link above will show. Fewer options in a county, lower reimbursement. Companies cherry pick where they want to setup networks and offer coverage because of reimbursement rates. Some carriers avoid counties because of the low reimbursement rates.

CMS star rating also impacts reimbursement rate. Here in NC, reimbursements average $700 per member per month. If you have a higher than average "star" rating with CMS (Fed agency that runs Medicare, Medicaid, and ACA), you get more reimbursements from the Fed. One company I know of lost 1/2 a star rating one year at the same time CMS moved the base reimbursement from 3 stars to a base of 3.5 stars. Cost the company around $92 million that year in reimbursement...Ouch.

MA plans in FL, TX, and NY are much richer benefits because the reimbursements are much higher. Companies can offer more bells and whistles in those areas than companies in more rural areas.  I have a friend that works in FL in the Medicare market.  We compared benefits on some of what he offers and what's available up here a couple years ago.  Night and day for sure.

Hope that helps!
R


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## Pappy (Nov 15, 2016)

If it's any help, I live in Florida and have United Healthcare Advanced and VA benefits. I keep my primary, local doctor as my go to person when I am sick and need a shot or medicine right away.
The VA is a bit of a drive, but I do use them for hearing aids, expensive medications, minor operations and a few other things.
i try to balance them out as to where I can get the best, and least expensive  treatments. 
I do use a few very expensive drugs.
Ex: Symbicort $145.00 for 90 days
VA: $27.00 for 90 days
The VA will not cover the new very expensive heart meds, so I have to bite the bullet on that one. 
Hope this has been some help.


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## jeb (Nov 15, 2016)

Hello Rusty and Pappy - and tks for the info.

As to the "welcome to NC", I was born and raised about half way between Asheville and Hendersonville at my grandpa's pottery but left the state right after high school.  Went through Navy flight school, 2 tours to Vietnam, went to a major airline then corporate flying.  Have been to many places around the world.  As my Son lives in Statesville - where I live now - and daughter in Raleigh, just coming almost home.  

As I have only seen my outside Dr once in 2+ yrs, have almost no medical problems at this time and could certainly use a little money every month, I am leaning towards cnxing my Humana PPO advantage plan.  I don't know if I pay anything now for the PPO plan I have with Humana.  I went to the link you gave me and could not find a way to see how much per month extra I would receive if I did cnx the plan - am I just missing it?

Pappy, I had my advantage plan in FL with Optima - an amazing little company that covers some parts of FL.  I think they are owned by a group of Dr and they are heavy into preventive medicine. I would get an email from Optima saying something like, "tell your Dr you need a bone density scan."  If it was not done in a reasonable time period they would call me.  And unlike every other Dr. I had been to that maybe spent 5 mins with me, my Dr. would go over in detail my blood test or any other test I had.  Highly recommend them.

Again, tks for the help to both of you. - jb


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## jeb (Nov 15, 2016)

Rusty, I called Humana and they said I would receive nothing back if I cnxed my plan as I don't pay anything each month for the plan.  Does this sound right?

Tks - jb


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## Pappy (Nov 15, 2016)

At the present time jeb, I need an insurance I can take with me and United Healthcare gives me that option. We still go to NYS for 5 months and I need the coverage for both places.
once I decide to stay in FL, I'll look into a couple of different plans. Thanks.


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## RustyatMMC (Nov 16, 2016)

jeb said:


> Rusty, I called Humana and they said I would receive nothing back if I cnxed my plan as I don't pay anything each month for the plan. Does this sound right?
> 
> Tks - jb



Jb,
It appears you have the $0 HumanaChoice R5826-063 (Regional PPO) without drug coverage.  Since you get meds through the VA that's likely the case.  If that is what you have; you are getting coverage for "free." 

http://www.ncdoi.com/_Publications/... County 2017/2017 MA Landscapes - Iredell.pdf
This is a link for what is offered in Iredell County for 2017.  If you notice under the drug coverage column, it's blank, which means there is no drug coverage included.

You could keep it or do without.  If you keep it, you are limited to their in-network doctors at a lower rate, and out of network doctors at a higher rate.  If you drop it, you are open to all the doctors that accept Medicare.  You would want to look at any additional benefits it offers to determine if it's worth keeping.  Below is the benefits page of that plan.

http://www.ncdoi.com/_Publications/...its/HumanaChoice (Regional PPO) R5826-063.pdf

Hope that helps.

Welcome back to NC!

Rusty


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## Butterfly (Nov 16, 2016)

Why would you think you'd get anything "back" if you are not paying anything for it?  The medicare premium we all pay is the same whether you have an advantage plan or not.


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## jeb (Nov 17, 2016)

Well, I assume that the ins companies are getting payments from Medicare - they don't do it for free.  If I no longer use an ins plan and I am not using Medicare as I am going to the VA, that money goes somewhere.  Why would I not get the money.

When I was in FL, I received an amount more in my SS each month because I had VA paid drugs - in NC I do not.  Where did that money go?


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## Manatee (Nov 18, 2016)

I have a Humana Advantage plan and I have eligibility for VA coverage.  I found it much easier to access the Dr for Humana than the VA facility.  My wife is also on the Humana plan, but would have no coverage from the VA.  I have lower level eligibility because I served in between any wars.

I was advised by friends to get the VA card because they will cover some meds that insurance companies won't.


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## Butterfly (Nov 19, 2016)

jeb said:


> Well, I assume that the ins companies are getting payments from Medicare - they don't do it for free.  If I no longer use an ins plan and I am not using Medicare as I am going to the VA, that money goes somewhere.  Why would I not get the money.
> 
> When I was in FL, I received an amount more in my SS each month because I had VA paid drugs - in NC I do not.  Where did that money go?



Call Medicare at the 800 number and ask them what's the scoop.


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## Dudewho (Nov 30, 2016)

Manatee said:


> I have a Humana Advantage plan and I have eligibility for VA coverage.  I found it much easier to access the Dr for Humana than the VA facility.  My wife is also on the Humana plan, but would have no coverage from the VA.  I have lower level eligibility because I served in between any wars.
> 
> I was advised by friends to get the VA card because they will cover some meds that insurance companies won't.



I've been told that "life style" drugs such as ****** or Cialis are not be covered by Medicare Rx Plans. 
I've heard the VA does cover them. Although I'm not an expert on the VA because I am not a veteran.
 As far as for Humana, I know they have a very strong drug formulary. I haven't seen too many problems with drug coverage with them.

PS. Thank you for your service


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