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News From The Health Insurance Store

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I’m a retired Federal Employee and have a Blue Cross Blue Shield plan and Medicare. Am I losing access to UPMC doctors and hospitals next year?

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You will continue to have network access to UPMC doctors and hospitals as long as you have both Medicare Parts A and B. Those who have A only, will not have network access to UPMC.

I’ve been having ongoing discussions with a very informed representative of UPMC who assured me of this. As or more importantly, he also gave me an update on what the process will be for those who may still have Highmark Medicare Advantage HMO’s and PPO’s after June 30th of next year and wish to use UPMC health systems. I’m her to tell you, it’s going to be extremely inconvenient if you remain on your Highmark Medicare Advantage HMO or PPO.

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From John in Moon: I already have a Supplement and I’m very happy with it. Is there anything I need to do during Medicare Annual Election?

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Yes John. You will want to investigate a couple of things during Annual Election Period (AEP), which starts October 15th, and runs through December 7th. Frist let me briefly remind everyone that not all Medicare plans are Supplements. In fact, I estimate that at least 50% of seniors in our market have Medicare Advantage Plan HMO’s or PPO’s that are NOT secondary to Medicare. These plans are NOT designed to pick up the portion of the bill Medicare doesn’t pay, like the 20% for outpatient services. Very few people understand that.

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From Joyce in the North Hills: Since my HMO will no longer provide access to UPMC hospitals and doctors next year, I am considering moving to a Supplement. But I don't want to lose Silver Sneakers or my dental and vision benefits. Can you comment on my concerns?

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Absolutely Joyce. First, I want to remind everyone Advantage Plan HMO's and PPO's like Joyce has are NOT Supplements and are NOT designed to pick up the portion of the bill Medicare doesn't pay. Instead of paying 80%, when you have an Advantage Plan, Medicare instead pays the company you choose approximately $800 per month to become your one and only insurer. In return they provide your medical benefits and pays claims. You, the insured, are then responsible for a deductible (very few plans have one), coinsurance (a percentage of the bill you are responsible for, commonly 20%), and/or a co-pay for virtually every service you receive. Here's some examples of what your medical bills could be: $5 for a PCP visit. $40 for an X-Ray. $200 for an MRI, $300 to $2,000 for an inpatient hospitalization, up to $6,700 for Chemo or a lengthy Skilled Nursing stay.

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I don't fully understand deductibles and what all is included in the Maximum Out of Pocket expense. Would you please explain?

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You are not alone Don. If it were easy to understand, I wouldn't be in business. Let me clarify as it applies to Medicare plans, and explain what co-insurance and co-pays are
as well.

The deductible is the amount of money you must pay for certain medical services before the insurance company will pay any portion of the bill. Let me give you an example.

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I have a Medicare Supplement Plan F and been told that it will be discontinued in 2020. What does that mean for me? Should I change my plan now. Am I going to lose my plan?

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That's a great question. Indeed, Medicare Supplement Plans F and C will no longer be available for purchase after January 1st, 2020. However, you will be able to remain on the plan if you would like. Medicare Supplements, aka Medigap, are highly Federally regulated. One of the regulations states you cannot be forced off a discontinued plan, and benefits must stay the same so long as premium payments are made. I do have a couple of concerns about remaining on either plan F or ( however. Those plans have become quite expensive over the last few years.

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