Kaiser Medicare Advantage

[SandyClaus]

It's official, I'm an old guy now.

And it looks like the Kaiser Medicare Advantage Plan is the way to go for me.

I asked the rep what about foreign travel, and they said I'm on the hook for any medical expenses while out of the country, but that I can apply for reimbursement when I get back to the US.

That begs two questions:

1. Does anybody here have any personal experience with this, or preferably with getting reimbursed from Kaiser specifically?

2. How do you cover the expense out of country? Large credit card amounts or extra cash in an account linked to a debit card?

Any input will be greatly appreciated!

 

[surfgoose]

Which medical advantage plan that you choose depends a whole lot on where you live and what doctors and hospitals are available to you. Here in SoCal we are very fortunate to have a wide selection, my family members in northern Arizona are a lot more restricted in choices. I suggest that you explore AARP's Medicare Advantage plan through United Healthcare before deciding. I'm up the road in Long Beach, and it has been VERY good for my wife and myself. Lots of different hospitals, huge numbers of doctors of all kinds, very good costs on the multiple meds we take (most are free!)

 

[SandyClaus]

Thanks Surfgoose!

I'm leaning towards Kaiser because I'm surrounded by their hospitals and offices within a couple of miles.

My main concern is how to plan for and handle any medical emergencies out of country.

 

[alphamale]

Access to specialists may be restricted. Not a problem if you don't get sick. If you are used to being able to go where you want and see any type of physician you will not be happy. That is why so many Medicare patients still have Medicare/PPO because they want options. 52 percent of people are not on advantage plans. You get what you pay for in life. Medicare part D and advantage plans may not cover chemotherapy.

 

[SandyClaus]

Access to specialists may be restricted. Not a problem if you don't get sick. If you are used to being able to go where you want and see any type of physician you will not be happy. That is why so many Medicare patients still have Medicare/PPO because they want options. 52 percent of people are not on advantage plans. You get what you pay for in life. Medicare part D and advantage plans may not cover chemotherapy.

Thanks Alphmale!

Fortunately I'm not sick, and don't really get sick. I don't have a doctor and don't take any meds, unless we're counting beer as a med

I'm more concerned about experiences with out of country medical emergencies and how to properly plan for them.

 

[MYNomad]

Access to specialists may be restricted. Not a problem if you don't get sick. If you are used to being able to go where you want and see any type of physician you will not be happy. That is why so many Medicare patients still have Medicare/PPO because they want options. 52 percent of people are not on advantage plans. You get what you pay for in life. Medicare part D and advantage plans may not cover chemotherapy.

I am maintaining my PPO coverage because I want to "keep my doctor". What is Medicare / PPO and is there a way to save money AND have the same coverage (or better) that I have no (no life time limit, for example).

 

[CI_SeaWolf]

I have experience with having a medical claim in Canada years ago. I had Kaiser at the time. I was admitted to an ER in remote BC for an inner ear infection. I paid out of pocket, even got a guest pass into the Canadian National Health system. Submitted documents for reimbursement to Kaiser and got my money back.

 

[jer dog]

I have experience with having a medical claim in Canada years ago. I had Kaiser at the time. I was admitted to an ER in remote BC for an inner ear infection. I paid out of pocket, even got a guest pass into the Canadian National Health system. Submitted documents for reimbursement to Kaiser and got my money back.

I have Optum , and they have been great , years ago I went to Saint Joseph
for A Emergency , and they took care of the whole Bill,
and I have A HMO , I heard good and bad with Kaiser,
my daughter in law has it , and hates it .

 

[SandyClaus]

I have experience with having a medical claim in Canada years ago. I had Kaiser at the time. I was admitted to an ER in remote BC for an inner ear infection. I paid out of pocket, even got a guest pass into the Canadian National Health system. Submitted documents for reimbursement to Kaiser and got my money back.

Thanks Cl_SeaWolf!

 

[SandyClaus]

I have Optum , and they have been great , years ago I went to Saint Joseph
for A Emergency , and they took care of the whole Bill,
and I have A HMO , I heard good and bad with Kaiser,
my daughter in law has it , and hates it .

Thanks jer dog!

If it's not too much to ask, what does she hate about Kaiser?

My wife had one of the most Expensive Cadillac PPO plans available, and we hated it. Yes, you had a lot of flexibility with Doctors, IF you could get to see them. Often took months to see one, and the amount of paperwork was insane. Getting her prescriptions was a whole other battle. Nobody cared or really did anything to help, it was always somebody else's fault.

 

[jer dog]

Thanks jer dog!

If it's not too much to ask, what does she hate about Kaiser?

My wife had one of the most Expensive Cadillac PPO plans available, and we hated it. Yes, you had a lot of flexibility with Doctors, IF you could get to see them. Often took months to see one, and the amount of paperwork was insane. Getting her prescriptions was a whole other battle. Nobody cared or really did anything to help, it was always somebody else's fault.

five months ago she had A baby , and she didn't have A personal doctor,
it was A doctor that was on the clock ,
she called it A meat market .

 

[bob_marlin]

I have had Kaiser since 1978...never a problem

three of my golf buddies also have Kaiser and not a complaint from any of us...sadly we now talk about health care and our aches and pains

 

[Fins in the Bin]

lots of Kaisers in Hawaii, go there for vacations!

 

[SandyClaus]

five months ago she had A baby , and she didn't have A personal doctor,
it was A doctor that was on the clock ,
she called it A meat market .

Really sorry to hear about her experience, but it's good to get other people's honest feedback.

Thanks.

 

[SandyClaus]

I have had Kaiser since 1978...never a problem

three of my golf buddies also have Kaiser and not a complaint from any of us...sadly we now talk about health care and our aches and pains

Thanks bob_marlin!

 

[jer dog]

Really sorry to hear about her experience, but it's good to get other people's honest feedback.

Thanks.

Not when it comes down to delivering,
With my wife and blue shield, she had the
Same Doctor from the beginning to the end.

 

[RideHPD]

I don't think any plan offers significant coverage outside of the US, that's what travel insurance is for. IIRC it used to be a perk for AMEX that it was complementary if you paid for travel/accomodations with their card.

 

[terryc.]

I to stayed with Kaiser, Medicare starts in Feb. We have had Kaiser for several years now with good results but like you I'm 64 and healthy no meds as of yet.

 

[bajachild]

Kaiser kills. Literally. I know first hand.

 

[smokinwater]

Ok, Sandy, I think I can help with what info you're looking for: stepped off a bus in PV and fell into a pothole, blowing out my quadricep tendon. (Interject I was completely at the mercy of Mex nationals and was treated so amazing wonderful by everyone!) I was carefully put in a taxi, wife at my side and off to a hospital. Xrays, antibiotics, pain meds by IV, and scheduled for surgery. I asked about just shoving me on a plane north but was advised airlines wouldn't accept me for travel as I would be considered non-stable. Pre-op included Internal Medicine dr workup, Ortho surgeon, anesthesiologist, and five days admitted post-op in a private room. All meals, continuing meds, round the clock nurse. Given my complete medical report for kaiser turnover, along with a Statement of Medical Clearance for the airlines. BTW, Mex Dr was completely correct about being non-stable vs stable. Total for the bill: $5K and change. Yes, Sandy and BD, they want their money now! No problem, just run my card... rejected by VISA. Called credit union at home, explained to them it was me, card cleared the next attempt. (Even though I told CU I was traveling, bc of the size of the one charge they blocked it for safety.) Was taken directly to Kaiser once back across and placed in their care.
Administratively, Kaiser wants an itemized bill, drs report of findings and treatment provided. Of all that could have been the dumbest thing: Kaiser wanted me to sign a declaration, might have had to get it notarized if memory serves me right, that I didn't go to Mexico for the express purpose of getting a medical procedure done. Whatever. Within a couple of weeks they sent me my money.

Epilogue: 1) in the subsequent travels (flights) to Mex using CBX, I bought the airline's medical insurance, which I didn't do for this specific trip. However on my most recent travel by air, seems that I might not be allowed to purchase the medical insurance; travel agent read the fine print and it seems only available to Mex Nationals. Bottom line, research if you can get it, then do get it if permitted by your airlines. 2) There used to be an outfit that sold Mex travel medical insurance- not talking about car insurance. If anyone knows of this or similar, please post for information.

Hope all this helps answer your question.

 

[SandyClaus]

Ok, Sandy, I think I can help with what info you're looking for: stepped off a bus in PV and fell into a pothole, blowing out my quadricep tendon. (Interject I was completely at the mercy of Mex nationals and was treated so amazing wonderful by everyone!) I was carefully put in a taxi, wife at my side and off to a hospital. Xrays, antibiotics, pain meds by IV, and scheduled for surgery. I asked about just shoving me on a plane north but was advised airlines wouldn't accept me for travel as I would be considered non-stable. Pre-op included Internal Medicine dr workup, Ortho surgeon, anesthesiologist, and five days admitted post-op in a private room. All meals, continuing meds, round the clock nurse. Given my complete medical report for kaiser turnover, along with a Statement of Medical Clearance for the airlines. BTW, Mex Dr was completely correct about being non-stable vs stable. Total for the bill: $5K and change. Yes, Sandy and BD, they want their money now! No problem, just run my card... rejected by VISA. Called credit union at home, explained to them it was me, card cleared the next attempt. (Even though I told CU I was traveling, bc of the size of the one charge they blocked it for safety.) Was taken directly to Kaiser once back across and placed in their care.
Administratively, Kaiser wants an itemized bill, drs report of findings and treatment provided. Of all that could have been the dumbest thing: Kaiser wanted me to sign a declaration, might have had to get it notarized if memory serves me right, that I didn't go to Mexico for the express purpose of getting a medical procedure done. Whatever. Within a couple of weeks they sent me my money.

Epilogue: 1) in the subsequent travels (flights) to Mex using CBX, I bought the airline's medical insurance, which I didn't do for this specific trip. However on my most recent travel by air, seems that I might not be allowed to purchase the medical insurance; travel agent read the fine print and it seems only available to Mex Nationals. Bottom line, research if you can get it, then do get it if permitted by your airlines. 2) There used to be an outfit that sold Mex travel medical insurance- not talking about car insurance. If anyone knows of this or similar, please post for information.

Hope all this helps answer your question.

Thanks smokinwater, this really answers all my questions!

Sorry you had to go through all that, but it sounds like you got great care. And at $5k, that's a huge bargain compared to the cash rate at our hospitals where you'd probably have to pony up $125k.

Really glad to hear Kaiser stepped up and reimbursed you, even if you did have to wait a bit.

 

[yakdout]

Thanks jer dog!

If it's not too much to ask, what does she hate about Kaiser?

My wife had one of the most Expensive Cadillac PPO plans available, and we hated it. Yes, you had a lot of flexibility with Doctors, IF you could get to see them. Often took months to see one, and the amount of paperwork was insane. Getting her prescriptions was a whole other battle. Nobody cared or really did anything to help, it was always somebody else's fault.

My experience with Kaiser as well. Never again. Luckily I have a nice ppo through work.

 

[JTE]

You say you’re not sick and don’t get sick. Insurance is not for when you’re not sick. It’s for when you get really sick/hurt and need real medical help and specialists. That’s when you’ll be thankful you bought the best insurance you could afford. Any insurance, advantage or supplement, will get you in to see a crappy doctor that will renew you prescription for tier 1 meds. No medicare insurance is going to cover out of country costs, so it’s not even something you should use to compare insurance plans.

My advice, get a good Plan ‘F’ supplement policy. This will relieve you of almost all network concerns (anywhere in US) and relieve you of virtually all out of pocket costs.

My “never sick” wife was diagnosed with a serious immune system disease, and thank god we had Plan F. 6 months ago when we went to see her out of state specialist, the tests alone (done in one day) were over $16,000). No copayment on our part. Let’s see you get that kind of coverage with an advantage plan - you wouldn’t even get authorization to see the specialist that you selected.

Medicare insurance, even a good Plan F, is so much less than what you paid before you turned 65. For me, it’s about peace of mind. You get what you pay for.

Medicare advantage plan advertisements are plentiful. When was the last time you saw one for a Plan F supplement? The only reason the insurance companies offer good supplement plans is because they are federally mandated to do so (they don’t do it because they like or feel sorry for you).

Good luck with this.

 

[SandyClaus]

You say you’re not sick and don’t get sick. Insurance is not for when you’re not sick. It’s for when you get really sick/hurt and need real medical help and specialists. That’s when you’ll be thankful you bought the best insurance you could afford. Any insurance, advantage or supplement, will get you in to see a crappy doctor that will renew you prescription for tier 1 meds. No medicare insurance is going to cover out of country costs, so it’s not even something you should use to compare insurance plans.

My advice, get a good Plan ‘F’ supplement policy. This will relieve you of almost all network concerns (anywhere in US) and relieve you of virtually all out of pocket costs.

My “never sick” wife was diagnosed with a serious immune system disease, and thank god we had Plan F. 6 months ago when we went to see her out of state specialist, the tests alone (done in one day) were over $16,000). No copayment on our part. Let’s see you get that kind of coverage with an advantage plan - you wouldn’t even get authorization to see the specialist that you selected.

Medicare insurance, even a good Plan F, is so much less than what you paid before you turned 65. For me, it’s about peace of mind. You get what you pay for.

Medicare advantage plan advertisements are plentiful. When was the last time you saw one for a Plan F supplement? The only reason the insurance companies offer good supplement plans is because they are federally mandated to do so (they don’t do it because they like or feel sorry for you).

Good luck with this.

Thanks JTE!

Sorry about your wife, I hope she's fully recovered!

I didn't even know there was a Medicare Plan F, so I looked it up.

Apparently it's even more complicated... there's also a Plan G, Plan K, Plan L, Plan M and Plan N, with different state requirements.

And according to the medicare.gov website, you can't get a Plan F anymore.

"As of January 1, 2020, Medigap plans sold to people new to Medicare can no longer cover the Part B deductible. Because of this, Plans C and F are no longer available to people new to Medicare on or after January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you can keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans (Plan C or F)."

It would be nice if we overhauled and simplified our healthcare and insurance here in the US, but there's so much money and special interests involved I just don't see it happening in my lifetime.

And for myself personally, I'm surrounded by some great Kaiser doctors and facilities, so it's kinda a no-brainer for me.

 

[michael e. bingham]

My parents had Kaiser and they hated it , my medical p,an is Sharp VIP advantage and along with medi care I'm 100 percent covered anywhere I go , no copay , 2 dollar prescriptions, no emergency room charge , I choose this in order to keep all my doctors thatI I've been with for years, I pay $499 a month though, I had surgery November 7th and I'm just now getting back on my feet and it didn't cost me a dime , I have a good fishing buddy for 50 plus years now and he loves Kaiser , I guess it's like anything else, you always don't come out on the winning side, it's who you are comfortable with and I opted to pay monthly in order to keep the same facilities and doctors