Question
I have had a MedicareComplete plan from Secure Horizons for 3 years. I recall that when I initially signed up the number of choices was confusing in spite of attending a workshop which attempted to explain the differences. The woman running the workshop (???) recommended the Balance plan for me. In July I had a colonoscopy and endoscopy at the same time at an ambulatory surgical center at St Luke?s Hospital in New York City. This apparently triggered my medical annual deductible though I don?t remember it being described that way. I believe that the woman said it was only if I went into the hospital. I believed that routine recommended tests would be covered especially the colonoscopy.
Apparently I did not have any services in 06, 07 and 08 which triggered this deductible. I fully felt that the colonoscopy and the endoscopy which was recommended after an upper GI series to check for Barrett?s esophagus would be covered.
As a result of this surprise bill I am reconsidering which of the MedicareComplete plans I should be on and may switch when during the open enrollment period later this year. I looked at the 6 plans available and am now totally confused. The balance plan is the only one with a Medical annual deductible ($2050). Two of the plans (Plan2 and Plan3) have a medical out-of-pocket maximum ($ 2400 and $3250). One plan the Medicare Complete Essential Offers no drug coverage and is described as a ?plan for individuals who do not require drug coverage but want medical benefits beyond traditional Medicare?.
I have the following questions:
1. What is the difference between a Medical Annual deductible and a Medical out-of-pocket Maximum?
2. What benefits do the plans without the Medical Annual deductible and a Medical out-of-pocket Maximum offer to make up for this large outlay of cash?
3. What are the benefits the Essential Plan offers which are described as ?medical benefits beyond traditional Medicare?.
4. I am a very healthy person (age 69) who only goes to the Dr once or twice a year for routine testing. I have never been in a hospital, take no medication, and have no chronic illnesses. Will one of these plans work for me? Or should I revert back to the regular medicare coverage?
Answer
Hi Nancy
Kind of a bad time to ask these questions, but, a good time because the open enrollment periods are not far away. You probably used the 200 informational packets to make your search. All the
Advantage plans on the 09 list will, in effect. be gone effective New Years Eve.This is because they all have at least some minor changes. Within the next two or three weeks, you will get a copy of MEDICARE AND YOU 2010. If you do not get a copy, go to the local Social Security office and pick one up. In the back of the book there will be a list and information for all the Advantage and Prescription plans in your area with the 2010 information. In the center of the back cover is the local phone number for the SHIP program for your area. These are Medicare trained counselors, Give them a call after Oct 15th and they will help you find all your options so you can make your own decision,
Hope this is helpful
John
