I thought that I would have made a decision about Medicare by now and I haven’t. I don’t feel that I am much closer to a “right” decision than I was a few months ago. I have narrowed my choices to 3 plans: 2 Cost plans and 1 Supplemental plan. Each plan has definite pluses and minuses.
About 6 weeks ago I was close to making the decision to go with one of the Cost plans offered by BCBS of MN. The advantages of this plan are reasonable cost, excellent coverage for pump supplies, formulary inclusion for all of my drugs, and a preferred test strip brand that I am satisfied with. It allows me to use BCBS DME suppliers without dealing with the Competitive Bidding suppliers of Basic Medicare. With this plan I will have 12 months to change my mind and switch to the BCBS Supplemental plan with no consideration of pre-existing medical conditions. Therefore I can stay on this plan for all of 2017 and have all Medicare options available in 2018. The major disadvantages of this plan are no CGM coverage and that starting in 2017, Walgreen’s is not a preferred pharmacy. I have always had great service with Walgreen’s and my first choice is to stay with them.
A couple of weeks ago it was announced that Fairview, one of the major health systems in Minnesota, has not come to a network agreement with BCBS for 2017. Therefore many of my health providers will be out-of-network if I choose a BCBS Cost plan. I believe that an agreement will eventually be reached, but….
The second Cost plan that I am considering is offered by HealthPartners. The main advantage of this plan is that it provides CGM coverage. It should be a no-brainer to go with this plan, but co-pays for pump supplies and test strips cost substantially more than on the BCBS plan and the total cost of the two plans is about the same. Plus the preferred brand of test strips for HealthPartners is one that I have not had good success with. I will only have 6 months to revert to Basic Medicare and a Supplemental plan and I will need to re-evaluate my options partway through 2017.
The Supplemental plan that I am considering is BCBS Senior Gold. The advantages of Senior Gold are that benefits will never be reduced in the future and I can take the plan with me if I move out of Minnesota. With this plan I will experience few or no out-of-pocket costs. There are no network restrictions and I can see any provider who accepts Medicare. I can always choose to switch to a Cost or Advantage plan in the future. The downside is that Supplemental plans follow Medicare guidelines and there is no CGM coverage. Also I will be forced to use Competitive Bidding suppliers for mail order test strips and pump supplies. I will be required to see my endocrinologist every 90 days in order to receive pump supplies. Although this plan allows the most flexibility for future coverage, it is substantially more expensive than the two Cost plans I am considering.
I don’t know what I am going to choose. I have a list of questions that I will present to an insurance broker I have been in contact with and to a representative from my local SHIP agency. Because I do not need to make my decision until February, I have avoided recent contact with these consultants until the Medicare Open Enrollment period ends today.
Last month I wrote about the anxiety I was experiencing as I thought about Medicare. Today I am not worrying about it. Frankly there are so many unknowns that I am beginning to think that it may not matter what I decide. I have written that Medicare Cost plans are unique to Minnesota, Wisconsin, and a few other states. I was told by a representative from BCBS of MN that these plans will probably be disappearing in the next year or two due to pressure from Medicare. They will be replaced by Advantage plans with different guidelines and network restrictions but more similar to plans offered in other states. The plan I select now may possibly not exist in two years. I know people with diabetes who are using Supplemental plans. I know people with diabetes who are using Cost or Advantage plans. Whatever I select, I will be part of a population of people with diabetes who are in the same boat as I am.
Meanwhile a Trump presidency along with a Republican-controlled legislature is an indication that we may see substantial changes to Medicare in the coming years. Will current Medicare beneficiaries be exempt from future changes or will we all move into a new unproven system? What will happen to people with pre-existing conditions and serious illnesses?
I don’t know the answers to these questions. The only thing I know is that there may not be a “correct” decision for me to right now. There are different decisions. There is Plan A, Plan B, and Plan C. Maybe my choice will make a difference. Maybe it won’t.
I just don’t know.
Please note that Medicare began reimbursing the Dexcom G5 continuous glucose monitor in 2017. Most of my concerns in the Countdown to Medicare series are still relevant. But the details may have changed by the time you read this post. Laddie 6/28/18
Thank you for keeping me informed! I appreciate all of your research! I live in North Carolina and am 62 with your same concerns for my future. Thanks again!
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Your thoughts are just as muddeled as mine!!! And I hope you don’t take offense at that, none is meant. I have entertained another selection: Just let go of the angst of the CGM denial process and pay the reduced price Medtronic offers for the CGMS sensors. ( I am grateful to God each day for the blessings He has provided for me, including a wonderful husband who worked many years to earn a decent pension) If I can really budget , I may go with this choice. I also pray for those less fortunate and my heart aches for them.
Have you looked into the cost of your Dex com supplies if you bought them straight out. Meaning do they discount the cost at all?
Many thanks for the diabetes warriors and advocates who dedicate themselves to making this issue, and all diabetes issues their cause.
Yes, Kathy, I have spoken with Dexcom about the out-of-pocket expense for self-paying my CGM and have built those costs into my comparison of the total costs for each plan. There are times that I even consider going without CGM but after using it for 8-1/2 years, I would hate to go back to being blind to my BG. I’m glad to know that you are coming to terms with Medicare. I know many people doing fine with Medicare and I am optimistic that I will join their ranks.
Laddie, I used to oversee health insurance administration and I look at Medicare plans every year. Unfortunately, i cannot make diabetes sense out of the, I have no idea how people make a decision. A wise health plan consultant said wise decisions decrease by a factor of 2% for ever plan offering over 3. In this market I figure wise decisions have a 0% chance of getting made.
This item has been referred to the TUDiabetes Blog page for the week of December 5, 2016
Rick-your comment reinforces the idea that there is no “right” decision that will guarantee me a “right” answer as I transition to Medicare. At the same time I choose to be optimistic that I will thrive or at least do okay in my senior years with diabetes.