Medicare Complete
Medicare Complete- Secure Horizons offers PPO and HMO plans
You may be familiar with AARP Medicare Complete, but did you know that they offer both PPO and HMO Medicare Advantage plans depending on your service area?
Medicare Complete by Secure Horizons is underwritten by United Healthcare. They offer several plans depending on your County of residence. Medicare Complete, whether a PPO or a HMO is a Medicare Advantage Plan. Keep in mind that a Advantage Plan is not Medicare Supplement insurance, but rather another way to receive your Medicare benefits.
Medicare Complete has become a very popular plan, mostly due to the AARP brand. AARP is not the insurance company, but rather lends their name to the product much the same way that they brand life insurance and automobile insurance.
Which Medicare Complete Plan is better, a PPO or a HMO
There is plenty of debate as to whether a PPO or HMO is a better option. If you have an interest in a Medicare Complete Plan, this may be a mute point. You may have the option of enrolling in one or the other. But to be fair, here are a few differences.
Medicare Complete PPO Advantage Plan Pros
This plan offers plenty of flexibility. You are able to choose any provider, but will generally have lower out-of-pocket costs if you choose an in-network provider. In most areas, you are likely to find your primary care physician in-network. Specialists may vary from region to region and from one specialty to the next. This is not a huge problem, as out-of-network co-pays are not that much more than an in-network co-pay.
Medicare Complete HMO Advantage Plan Pros
The HMO plan will generally offer lower co-pays for providers. In addition, you may find more ancillary benefits and the ability to pay a small premium and add a decent dental plan. Be sure to ask about dentists who participate in the network, as this may be spotty. The United Healthcare Passport Program will allow you to receive your benefits in several other States, even though you are enrolled in a HMO.
Other Secure Horizons Medicare Advantage Plans
In addition to Medicare Complete Advantage Plans, Secured Horizons offers a private-fee-for-service plan (PFFS) in several service areas. Private-fee-for-service plans do not utilize networks, but rather allow you to visit any Medicare approved provider that accepts the plan’s payment terms and conditions.
One point of caution with a PFFS Plan; the provider can accept the plan’s payment terms and conditions on a visit-by-visit basis.
If you can live with the uncertainty of not having a provider network, you may still find some value in this type of plan. For instance, if you prefer to receive service in another service area than where you live, you may find a PFFS plan will give you the flexibility to receive care out of you service area.
Medicare Complete and PFFS Plans offered by Secure Horizons are a choice worth considering if you considering a Medicare Advantage Plan.
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Comments
The following link will allow you to enter your area and criteria for your specific search.
https://www.securehorizons.com/ourplans/findaphysician.html
I hope this helps.
I have AARP/Medicarecomplete/HMO insurance. I want to change the PPO insurance now.Ask how wants to replace the insurance?The couple gather adds pays exprenses together.Ask how many insurance premium is?
Thanks for your help !
Hi William, The best thing for you to do is call United Health Care at 1-800-547-5514 or call a local insurance agent in your area. Thanks. David
Joe, There seems to be some confusion about Health Care Reform and 2011 Medicare Advantage plans. You will receive information about your 2011 AARP Medicare Complete plan in the mail. As with all Medicare Advantage plans, things can change from year to year. Secure Horizons Medicare Complete is a network based plan, and more than likely you will find that you will be able to keep the plan for 2011. Those Secure Horizons members with Medicare Direct, a PFFS plan, may not be as fortunate and may need to look for another option.
Watch for any communications from Secure Horizons as it relates to your 2011 AARP Medicare Complete plan and review you benefits to determine if keeping the plan will be right for you. I think it will be a good option for 2011. I comment on many different plans and do not speak for Secure Horizons.
HiDavid; I have AARP Medicare complete Plan1/HMO,The Cleveland Clinic where my specialists,Nephrology,Urology are located are out of network and my insurance will not pay anything.representatives lied during enrollment period and misinformed me that i could go to the Cleveland Clinic!If I do go to the Cleveland clinic for treatment will I be billed under medicare 80-20%? or in effect have i been kicked out of Medicare,by going to an out of network hospital.Appreciate any help. Philip
Philip, I’m sorry to hear about your situation. If you are enrolled in an HMO, you must receive your care from network providers unless it an emergency. When you are enrolled in an Advantage plan, your Medicare is administered by the insurance company and you cannot opt-out temporarily to receive care under the 80% / 20% original Medicare model.
I know it’s frustrating now, but your plan is an annual plan and you have the right to make a change during the Annual Enrollment Period. If you are going to stay with an Advantage plan, check to see if you have any PPO plans that look good. You still have a network, but can receive care out-of-network generally for a little higher co-pay. You may want to explore returning to original Medicare and looking into a Medigap policy. Medicare supplement plan N is a good alternative to an advantage plan. With a Medicare supplement you will not have network restrictions.
Medicare Advantage plans for 2011 will be announced October 1 and you can look at those that are available in your area, as well as any Medicare supplement plans that may fit your needs and budget.
Thank you for your reply.Are you saying that if I elect to be treated at Cleveland clinic I am responsible for 100% of all charges?
That is my understanding of how an HMO works, unless you have some clause that will allow out-of-network for an additional fee, like a PPO. To be certain, verify this information with a licensed agent or call the number to the plan on the back of your card. Good luck.
Curently I have a supplemental plan with United Health Care. How is Medicare Complete the same/different from
my supplemental plan. I understand that their is a copay with Medicare Complete but wouldn’t the charges overall be much less than my monthly fee for the supplemental plan that is getting more and more expensive every year? I have no pre-exhisting conditions.
Thank You
Joan Wallace
Joan, Good questions. A supplement is technically referred to as a Medigap policy. It fills in the gaps of Medicare-covered expenses. You will in most cases have a higher monthly premium than a Medicare Advantage plan, but will generally have greater freedom to choose providers and not be subject to an annual plan that can change or not renew for the following year.
An Advantage plan is not a Medicare supplement. You are receiving your Medicare benefits from a private insurance company that has been approved by CMS to administer your Medicare. With an Advantage plan you will most often have network restrictions, and a greater level of cost sharing, such as; co-pays, coinsurance and deductibles. The positives will be a lower monthly premium and perhaps some extra benefits like dental and vision. I look at it this way: A Medicare supplement is “pay me now” and the Medicare Advantage plan is “pay me less now and maybe more later”. Here’s an article about MedicareComplete that may be helpful. Medicare Complete – Is it a Medicare Supplement Or Medicare Advantage Plan?
Richard, The 2011 Provider directory for AARP Medicare Complete by Secure Horizons lists two hospitals in Volusia County Florida, Bert Fish Medical Center and
Halifax Medical Center
1041 Dunlawton Ave.
Port Orange, FL 32127.
(386) 322-4700
I hope this helps. David
My Mother is on Medicare. Her current ins ends in December and we need to look for another. I’m not sure if she needs the supplement or the advantange. With either choice the plan will need to cover the drug Januvia (sitagliptin). We live in New Hanover county, NC.
Wendy, Here’s an article on Medicare Advantage versus Medicare supplement plans that may give you some insight as to which way to go. Keep in mind that a Medicare supplement does not include drug coverage and your Mother will need to purchase a Part D plan if she chooses a supplement.
If she is leaning towards an Advantage plan, it would be wise to compare several plans, as the benefits and provider networks may vary widely. A supplement, on the other hand will offer standardized benefits, but the price may vary widely.
David
Richard, Contact Social Security and let them know you would like to enroll in Medicare Part B. Once you have Part B you will be able to either purchase a Medicare supplement or enroll in a Medicare Advantage plan. If you choose to compare Medicare supplement policies, you will have an Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you are both 65 and enrolled in Medicare Part B. During this time an insurance company cannot refuse to sell you any supplement that they see, make you wait for coverage or charge you more due to your health. If you purchase a Medicare supplement, you will need to also purchase a stand-alone Part D policy, as they are not included in a supplement.
If you choose to explore Medicare Advantage plans, you will have a Special Enrollment Period. If you have end-stage renal disease you cannot join a Medicare Advantage plan. Plans are annual plans and can benefits can change each year or the plan may not renew for the following year. You can choose an Advantage plan that includes Part D drug coverage and not need to purchase a separate drug plan. Sign up for our free 5 part mini-course on Medicare Advantage plans if you have not already done so.
David
My parents have Medicare Part A and Blue Cross / Blue Shield of Rhode Island BLue Chip for Medicare, Part D.
We were looking a the Secure Horizons Secure Advantage PPO.
My father has had a heart attack, pace maker/defibrulator adn a small bout with colon cancer, although several years ago. My mother has Alzheimer’s.
Would switching over to Sevure Horizons be a better deal?
Ed, Without greater knowledge about their current plan and what constitutes a ‘good deal”, it would be irresponsible for me to advise you on this matter. I would become very familiar with the Blue Cross Blue Shield benefits they currently have and then speak with a local insurance agent who represents several plans. Let the agent know about their current coverage and why you are considering a change. Let the agent know that you are just exploring your options. If you get any sense that the agent is more interested in selling you something rather than advising you… find another agent. If these were my parents I would proceed cautiously especially if their current coverage is from a former employer.
I was considering changing from my current Medigap policy to an AARP Complete plan. However, there are some detail that I am unsure about, and customer service was not able to clarify them. What would the co-pay be for expensive diagnostic procedures (e.g. MRIs or CT Scans), as well as in-office surgical procedures?
Frank, 2011 AARP Medicare Complete plans vary based on your specific location. Unfortunately Medicare Advantage plans lack the standardization that you enjoy with a Medigap policy, even with the same plan offered in different service areas. Visit http://www.aarpmedicareplans.com and locate the plan available in your area and locate the summary of benefits. This will drill down into the specifics you are looking for. For example the 2011 AARP MedicareComplete Choice Plan 2 (Regional PPO) offered in Florida, states this related to diagnostic tests: “20% of the cost for Medicare-covered diagnostic radiolgy services (not including x-rays).” That sounds like MRIs and CT Scans to me. The same benefit if you were enrolled in original Medicare.
If you do not find the specific information you are looking for, contact a local agent who is certified to offer AARP Medicare Advantage plans. He or she will generally get you answers if they feel an enrollment is a possibility.
I have just one follow-up question regarding coverage on the AARP Medicare Complete plan. The plan states that the policy holder is responsible for “20% of the cost of Medicare-covered therapeutic radiology services.” When they talk about cost, are they referring to the amount Billed (by the provider) or the amount Medicare would approve (assuming it was a facility that normally accepts assignment). As you know there can be a substantial difference between these two amounts.
Frank, The amount would be 20% of the amount MedicareComplete is required to pay the provider, which would be the lesser of the two amounts you referenced.
My mother has never had any type of insurance. My father usally took care of all of her Dr. bills. He passed away this year so I need to find her a insurance that she can afford on a very limited income. Any help in the right direction would be great.
She is 57 and lives in S.C.
Linda, If she is 57 and not yet eligible for Medicare you may want to contact a local insurance agent who represents multiple companies. Let the agent know up front about your mother’s budget and health. There are countless plans available and without greater information on your mother’s situation it would be irresponsible for any one to give you guidance.
David, wondering I need to sign my mother up for the Pres plan…she currently is a member of Medicare Complere by SecureHorizons. Do i enroll her in this program or just a Pres plan? Not sure what I actually have to do now?
Sandra, I’m not sure what the “Pres plan” is. If your mother is happy with Medicare Complete and she did not receive a letter indicating that her plan was not going to be offered in 2011, she doesn’t need to do anything. The plan will automatically renew. If she is not happy with the Secure Horizons plan she has until December 31 to enroll in another plan.
I live in Idaho 6months and Florida 6months. Can I use the complete plan? Idaho is my primary residence. I could use Florida only when really necessary
Karen, I believe that you can receive services in Florida by taking advantage of the United Health Care Passport Program. This program allows you to use network providers in another State. Both Idaho and Florida are part of the United Health Care Passport Program.
Note to Medicare Complete
I have lost my Medicare Complete card, and I don’t have a phone number to order another one. Please reply.
Thank you,
Richard (edited)
Richard, Visit http://www.aarpmedicareplans.com and select the contact link to submit your inquiry. They should be able to help you get a replacement card for AARP Medicare Complete.
Hi, As of 11/1/11, Medicare will be my new insurance. I am currently enrolled in Parts A, B, and C. I need to find insurance for my prescription drugs. I am currently on chemotherapy drugs which are quite costly. I am trying to find an AARP plan that will fit my needs. Also, I am 52 years old and on Disability. Can you help?
david- i am on AARP medicare complete now. am i allowed to purchase a supplement to cut down on expenses next year. i will need cataract surgery this december 2011 OR i can put it off until next year if i can save some money by going to a supplement. i understand i will be reqd to pay 20 % of the cost of the medical procedure. any ideas would be greatly appreciated.
Francisco, You are locked into the AARP MedicareComplete through December. Keep in mind if you submit an application for a Medicare supplement to become effective in January you will also need to purchase a stand-alone Part D plan. Check to see what your out-of-pocket will be if you have the cataract surgery in December under the MedicareComplete plan. It may be much less than the premiums for a supplement and Part D for a year.
What Radiology procedures do not need prior Authorization if the Patient has AARP Medicare Complete HMO MDCR?
Will Secure Horizon discontinue to pay for lab work for a family member who has Congested Heart Failure and Alzheimers’s? He needs his various blood levels monitored because of edema.
How does one find a list of medical and dental providers in Indianapolis, IN?