I need a supplemental insurance for Medicare?

Question

On Sept 2007 my son became a Medicare recipient because of disability. He signed up for American Progressive (AP) as the supplemental insurance to cover the 20% that Medicare would not cover. However, to our surprise, it turned out that AP "replaced" Medicare,and it only covers 80% of bills. Not only that, but two months later AP raised the premium from $46 a month to $64. Not only that, but my son needed home therapy and nobody in the area would take AP, so he ended up not having the home therapy that doctors had recommended. We are in the process of switching to a better health plan as supplement to Medicare. Any suggestions out there would be appreciated. HELP!

Answer 1

The plan he's on is a PFFS Medicare Advantage plan, not a Medicare Supplement. Actual Supplements are few and far between for anyone under 65 and are available only in a few states so a Medicare Advantage plan may be his only choice. They don't actually "replace" Medicare, they follow the same rules and regulations but the insurance company administers the plan.

These plans have two problems. First, PFFS plans don't have any doctor networks; you can go to any doctor that accepts Medicare and is willing to accept the plans payments. The problem is when most people call to see if it's accepted they get the receptionists who will look at their list of networks. Since the PFFS plans don't have networks it won't be on the list and the receptionist will tell you they don't accept it. You, or the agent that sold it to you, need to talk to the people in the billing department. Second, these plans are relatively new so even some billing departments don't know about them. The plan should have given you a sheet with information to give to the providers so they can find out the payment details. Once they know about the plan they'll usually accept them because they get paid the same amount as Medicare pays.

Medicare Advantage plans have annual contracts with Medicare so the premium can change on January 1. There is no premium guarantee period.

He might have other Medicare Advantage options depending on your location. There are other companies with HMO, POS, and PPO plans that have doctor networks. Most metropolitan areas have HMO plans while PPO plans are available in all but the most rural areas. Some people like these plans because of the network while others like the PFFS plans because of the freedom of doctor choice.

Chances are he is locked into the plan he has for another few months. Open enrollment runs from November 15 to December 31 for a January 1 effective date.

A local agent that works with all the major companies in your area would be the person to talk with because these plans are county specific. The agent will be able to explain how the different plans work. There is no extra charge using an agent.