Post by Admin on Dec 6, 2023 13:30:16 GMT -5
I broke down and switched. I joined Medicare about 1.5 years ago and selected OM(original Medicare) because at that time I could not find MA(Medicare Advantage) that included all my MDs.
But, my research and several brokers did not do a good job and I found exactly what I wanted. I have enough money but the difference is huge and why I switched to Aetna Medicare Signature (PPO) | H5521-360(content.sunfirematrix.com/2024/Aetna-Y0001-H5521-360-PR11-SB24-M-2024-SF20231201.pdf). I also talked to several people who have it for a while and are very happy.
Let's do a bit of math and compare to Plan G under OM..
Aetna Signature PPO
Monthly premium: Instead of $155+15 =$170, it is zero = rounding $2000. BTW the $170 was $150 last year. I asked couple of friends in their 70 and it's about $250.
Primary PCP=MD(actually it's per a group of MDs) = 0...Specialist=$25 (all my MDs and others are there). OM has $240 deductible, I don't. This means up to 10 specialists I'm ahead.
Prescription Tier 1-2 = no deductible. I have one prescription tier 3. Under OM I paid $1800, under MA only $800 = $1000 in savings.
Dental: preventive and comprehensive $2200 to any Dentist, including out-of-network, no deductible.
Vision: free eye check + $260 for glasses = $330-350. Already used it.
Extra Supports Wallet amount + High‑Value Provider Bonus ‑ additional $90 quarterly = $360 annually (you get a card). Already got the debit card and it's working. On the same card above more for food + utilities = $90 per quarter = $360 annually.
Silver sneakers=free membership to LA Fitness = 30 *12 = $360
Fitness reimbursment(camping, rowing, running equipment + classes) = $600. Already bought shoes and other equipment.
Hearing aid = $500
Transportation+ meals = Several told me they used it for surgeries and after that. My friends used that when they went for a surgery.
2000(premium)+1000(drugs)+2000(dentist)+350(eye)+720(wallet support)+360(LA fitness)+600(health equipment) about $7000.
The only worry what about max out of pocket. It is $5000 but far from reality. I also discussed the above plan with a broker who has over 900 people under this insurance that runs for years already and he also under it too + several people who have this plan and the most they ever paid was under $2000 annually which was rare. Several had typical surgeries(such as hernia and knee replacement) and had bills under $500. Several had 3 surgeries in one year and came under $1000.
Because it's a PPO I can go to other Doctors/Hospitals and pay max out of pocket. Saving every year over $6000 is too much to miss. Even if you have tier 1+2 drugs, it's still $5500 savings.
I also checked what if I had cancer or another severe case and I wanted to see another Doctor in Hospitals. MD Anderson isn't in network, but the Mayo clinic is and it has centers in Rochester MN, Phoenix, AZ, and 6 hours drive from my house to Jacksonville, FL 32224. I know several that went to MD Anderson for the initial check but continue in ATL to do all the services under their insurance.
Wait, there is more. Aetna sent a PA home to check my general health, I got another $50. When I do my annual exam, another $50. Customer service is just amazing.
But, my research and several brokers did not do a good job and I found exactly what I wanted. I have enough money but the difference is huge and why I switched to Aetna Medicare Signature (PPO) | H5521-360(content.sunfirematrix.com/2024/Aetna-Y0001-H5521-360-PR11-SB24-M-2024-SF20231201.pdf). I also talked to several people who have it for a while and are very happy.
Let's do a bit of math and compare to Plan G under OM..
Aetna Signature PPO
Monthly premium: Instead of $155+15 =$170, it is zero = rounding $2000. BTW the $170 was $150 last year. I asked couple of friends in their 70 and it's about $250.
Primary PCP=MD(actually it's per a group of MDs) = 0...Specialist=$25 (all my MDs and others are there). OM has $240 deductible, I don't. This means up to 10 specialists I'm ahead.
Prescription Tier 1-2 = no deductible. I have one prescription tier 3. Under OM I paid $1800, under MA only $800 = $1000 in savings.
Dental: preventive and comprehensive $2200 to any Dentist, including out-of-network, no deductible.
Vision: free eye check + $260 for glasses = $330-350. Already used it.
Extra Supports Wallet amount + High‑Value Provider Bonus ‑ additional $90 quarterly = $360 annually (you get a card). Already got the debit card and it's working. On the same card above more for food + utilities = $90 per quarter = $360 annually.
Silver sneakers=free membership to LA Fitness = 30 *12 = $360
Fitness reimbursment(camping, rowing, running equipment + classes) = $600. Already bought shoes and other equipment.
Hearing aid = $500
Transportation+ meals = Several told me they used it for surgeries and after that. My friends used that when they went for a surgery.
2000(premium)+1000(drugs)+2000(dentist)+350(eye)+720(wallet support)+360(LA fitness)+600(health equipment) about $7000.
The only worry what about max out of pocket. It is $5000 but far from reality. I also discussed the above plan with a broker who has over 900 people under this insurance that runs for years already and he also under it too + several people who have this plan and the most they ever paid was under $2000 annually which was rare. Several had typical surgeries(such as hernia and knee replacement) and had bills under $500. Several had 3 surgeries in one year and came under $1000.
Because it's a PPO I can go to other Doctors/Hospitals and pay max out of pocket. Saving every year over $6000 is too much to miss. Even if you have tier 1+2 drugs, it's still $5500 savings.
I also checked what if I had cancer or another severe case and I wanted to see another Doctor in Hospitals. MD Anderson isn't in network, but the Mayo clinic is and it has centers in Rochester MN, Phoenix, AZ, and 6 hours drive from my house to Jacksonville, FL 32224. I know several that went to MD Anderson for the initial check but continue in ATL to do all the services under their insurance.
Wait, there is more. Aetna sent a PA home to check my general health, I got another $50. When I do my annual exam, another $50. Customer service is just amazing.
