I just changed from emloyer provided health insurance to Medicare. I looked at advantage plans and found only one plan that covered insulin in my area. I went with a “G” gap plan allowing me to choose which pharmacy had the best insulin coverage. That took a lot of research.
I did the same thing. In addition, the G plan keeps you from being required to use physicians within a specific network. More options for sure.
FYI, I also learned that Medicare part B will pay for your insulin if you’re using an insulin pump.
Although I selected “I do not have health insurance”, what I actually mean is that I don’t have a separate, paid for insurance. I live in the United Kingdom of Great Britain and Northern Ireland, where are ‘insurance’ is our NHS (National Health Service), which is financed via direct taxation of all working people. You CAN, of course, opt to pay for an ‘external’ insurance, which has advanatages in that you get a higher priority treatment when needed.
Apart from the above, my medical needs, prescriptions, doctor’s consultations, etc. are all covered by our NHS system.
I think I have a good understanding of the basic structure and a clear understanding of the parts I need on a regular basis. I defy anyone to claim the have full knowledge of the DETAILS of every part of the whole plan
I have had the same coverage from Kaiser Mid-Atlantic for the past 32 years. I recently switched to Kaiser’s Medicare Advantage plan, but the coverage did not change much.
Between co-insurance, co-pays, and deductibles, it’s all ways to shift liability to the customer and give the company you pay to cover your needs less responsibility but more revenue. It would be nice to have an advocate on the individuals side.
I am on Medicare. And quite frankly, it makes no sense to me at all. I find it to be a giant step down from my previous employment health insurance plan.
It’s too bad the mail-order pharmacies don’t understand the plan as well. I’ve found one pharmacy that doesn’t even follow it’s own formulary applying it’s own interpretation to pre-authorization and quantity limits contrary to the the formulary.
I have Medicare as primary with Tricare for Life (military retiree) as secondary. It’s supposed to be a very good set up with most needs covered by one or the other. Tricare’s formulary seems grotesquely out of date for diabetes meds, but good for CGM and pump coverage. Medicare seems crazy as to what is/isn’t covered by which part. All of it seems written by lawyers for lawyers as a full employment scheme for them, convoluted and indecipherable by most people that actually need it.
I understand it way too well and it sucks that they don’t pay for my pump supplies (omnipod dash or the sensors and transmitters for my CGM) even though I met my deductible in January.
I am one of the lucky. I had 30 years experience in health care finance and my wife was career social worker who also assisted patients with their queries. Still not all Medicare policies or regulations make sense.
I understand. CIGNA recently changed pharmacy and DME providers to very stupid vendors. When I call CIGNA often get representatives who don’t understand and outright lie. CGM transmitter expiring July 17th. Ordered replacement June 18th. Solara never shipped it, repeated phone calls to Solara and CIGNA. Promised me, nothing came, No CGM for 7 weeks thanks to gross incompetence. CIGNA is employer provided, my part of the premium is 19% of my net income.
Switching insurance end of the year.
I know that I have to deal with referrals all the time, I know that when you have to switch plans (due to cost of premiums or employer changes) I have to “prove” that yes, I still have T1D, and that yes, there are adults with T1D, I know that shareholders are ore important to the health plan than those paying premiums (i.e. their customer policy holders). I have also learned that if I assist my HCP with the language getting something approved (one good one is comparing the costs to the health plan if they don’t cover pumps, CGMs etc) And I know that they change network providers, pharmacies etc at the drop of a hat, so call first!
I’m sure I don’t know every provision in my health care plan, but after several years of hitting bumps, I now understand everything I need to do to keep all my device supplies and all my meds delivered on time. Medicare is my primary, so that was quite a challenge. Two years ago I upgraded my secondary to an “enhanced plan” and my premium is a tad higher but I don’t have to worry about deductibles or copayments on my medical plan. I still have them on my prescription plan though. But all the maneuvers with the insurance plans I’ve faced thru out the years have kept my brain functioning. Trying to be positive. LOL.
I’ve tried, but the answers received before signing up last year have little relation to the EOB we’re receiving now.
I am on Medicare, Anthem Blue Cross supplement, and a senior RX plan with Cigna. Yes, I understand the plans and review them annually. Cigna is the best plan for insulin coverage by far, witha tier six for diabetics.
Not sure if I understand everything, but I believe I understand everything that I need to keep up with my health care. After seeing comments about medicare, I dread the day when that is something I will have to look into.
I am on a Medicare advantage plan with Aetna. I understand it well enough to get what I need, and if something new comes up I look at the manual or call the help line. Not difficult.
3 was my choice. Once married, I have my husband’s insurance plan along with choosing to keep just Medicare part b.
I do not understand how they play together, but I understand what/ who is covered and how to access needed information.
I’m on Medicare with a United Healthcare Supplement plan. Most of their language in the book is understandable but often not comprehensive enough and calling their number to inquire you getting some pretty interesting responses that I’m not convinced are accurate. Time and the medicare statements will answer those worries.
I am a retired nurse and I worked for a health plan . I recently changed health plans and the EOB is much clearer and the services are great even though it is a Medicare advantage plan. Humana has several good perks.
On a scale of 1-5, how well do you understand the details of your health insurance plan? (1 = the least, 5 = the most) Cancel reply
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Uh-oh. I checked 1 thinking that was the most instead of 5. Then I got around to doing “due consideration.” Medicare is primary. It has a 237 page book to explain details. So do some quantum mechanics text books. Therefore, I am quite sure I do not understand 237 pages of details in either of those books. Therefore, perhaps 1 really is the best answer. ¯\_( ͡❛ ͜ʖ ͡❛)_/¯