My mom has oxford healthplus medicare supplement insurance, can we switch to something else?

Question

my mom has oxford healthplus medicare supplement insurance. we've found many specialists do not accept oxford...she even tried to go to a regular dentist who also didnt accept it.

so can we switch out of it and go with something like aetna? is there an enrollement period or can you just do it whenever?

also, are medicare supplement insurances that charge you a monthly premium....say, $100....generally better or more widely approved than $0 plans?

my main concern is a catastrophic illness in the future and then trying to go to the best doctors only to find out that no one will take oxford.

many thanks

Answer 1

There are two enrollment periods. The first is November 15 - December 31 where you can make unlimited changes. The second is January 1 to March 31 where you can make one change but there are limits to what plans to which you can change with respect to drug coverage.

Your mom does not have a Medicare Supplement; she has a Medicare Advantage plan. There IS a difference. With a Medicare Supplement you can go to any doctor that accepts Medicare. Depending on the plan, her age, her health, and her location the premium could be anywhere from $100 to $350 per month. If she has health problems she could be declined. She would need a separate Part D prescription drug plan because no Medicare Supplements have drug coverage.

The Medicare Advantage plan she has is an HMO but there are other types. There could also be, depending on her location, PPO, POS, PFFS and MSA plans. Most of these plans do have a premium but it's usually much lower than a Medicare Supplement and most include Part D.

The PPO and POS plans have a doctor network. You can go outside the network but your costs will be higher.

The PFFS and MSA plans do not have a doctor network. You can go to any doctor that accepts Medicare but the doctor must be willing to accept the plans payments. The doctor can change his mind at any time so you'd need to ask the doctor each time you see him. The doctor can accept the plan from one person but not accept the same plan from another person.

It can get very confusing. Visit a local agent that works with all the major companies in your area to find the plan that will work best because I just gave you the basics and didn't even scratch the surface. With any plan you'll need to make sure any medications she is taking is on the formulary and you'll need to compare the drug costs of each plan. There can be hundreds of dollars difference each month in drug costs on different plans.

Dental is never included with Medicare Supplements and is seldom included with any Medicare Advantage plan unless it's medically necessary. Some Medicare Advantage plans will have limited dental, such as one cleaning, one check-up, and one X-ray per year. Some will have a dental option for a premium but these optional plans are also limited and you may have a to find a dentist in the network.